Meta-Analyses of Cisapride, Omeprazole and Ranitidine in the Treatment of GORD: Implications for Treating Patient Subgroups

Overview

Journal Clin Drug Investig

Date 2008 Mar 29

PMID 18370513

Citations 3

Authors

M Iskedjian

T R Einarson

Affiliations

Soon will be listed here.

Abstract

Objective: Meta-analyses of efficacy results reported in trials of the pharmacological treatment of gastro-oesophageal reflux disease (GORD) with cisapride, omeprazole or ranitidine were performed using randomised, double-blind studies identified by a Medline search covering the years 1984 to 1995.

Results: The overall order of efficacy following 12 weeks of acute treatment was omeprazole 40 mg/day (95% cured) > ranitidine 600 mg/day (81% cured) > cisapride 40 mg/day or ranitidine 300 mg/day (approximately 60% cured). However, important differences emerged regarding efficacy in mild versus severe GORD, and in the frequency of relapse. In mild GORD, the cure rate with cisapride 40 mg/day was greater than the cure rate with ranitidine 300 mg/day (56 vs 38%, respectively), and the cure rate with cisapride 80 mg/day was similar to the cure rate with omeprazole 20 mg/day (82 vs 75%, respectively). In severe GORD, the cure rate with cisapride 80 mg/day was half that of omeprazole 20 mg/day (43 vs 87%, respectively) and comparable with that of ranitidine 300 mg/day (50%). Among patients treated acutely with omeprazole, 6-month relapse rates were 17% with omeprazole 20 mg/day maintenance therapy, but 76 to 80% without maintenance therapy. Among patients treated acutely with cisapride, 6-month relapse rates were 33% with 20 mg/day maintenance therapy and only 40% without maintenance therapy, which compare favourably with those following 6 months' maintenance therapy with ranitidine 300 mg/day (49%).

Conclusion: These results indicate that omeprazole is clearly the treatment of choice for severe GORD, suggest that cisapride may be the treatment of choice for mild GORD, and indicate that either of these two treatments is superior to ranitidine for the prevention of relapse. Further comparative clinical studies are needed, designed specifically to delineate the most appropriate drug therapy for various subgroups of GORD patients.

Citing Articles

The impact of treatment for gastro-oesophageal reflux disease on health-related quality of life: a literature review.

Prasad M, Rentz A, Revicki D Pharmacoeconomics. 2003; 21(11):769-90.

PMID: 12859219 DOI: 10.2165/00019053-200321110-00002.

Gastroesophageal Reflux Disease.

Hila A, Castell D Curr Treat Options Gastroenterol. 2003; 6(1):41-48.

PMID: 12521571 DOI: 10.1007/s11938-003-0032-7.

Omeprazole. A review of its use in Helicobacter pylori infection, gastro-oesophageal reflux disease and peptic ulcers induced by nonsteroidal anti-inflammatory drugs.

Langtry H, Wilde M Drugs. 1998; 56(3):447-86.

PMID: 9777317 DOI: 10.2165/00003495-199856030-00012.

References

Guslandi M . Cimetidine plus cisapride for reflux oesophagitis. Lancet. 1988; 2(8604):229. DOI: 10.1016/s0140-6736(88)92345-8. View

MALEEV A, Mendizova A, Popov P, Vlahov V, Dimitrov B, Mihova A . Cisapride and cimetidine in the treatment of erosive esophagitis. Hepatogastroenterology. 1990; 37(4):403-7. View

SANDMARK S, Carlsson R, Fausa O, Lundell L . Omeprazole or ranitidine in the treatment of reflux esophagitis. Results of a double-blind, randomized, Scandinavian multicenter study. Scand J Gastroenterol. 1988; 23(5):625-32. DOI: 10.3109/00365528809093923. View

Guslandi M, Testoni P, Passaretti S, Masci E, Ballarin E, Comin U . Ranitidine vs metoclopramide in the medical treatment of reflux esophagitis. Hepatogastroenterology. 1983; 30(3):96-8. View

Roufail W, Belsito A, Robinson M, Barish C, Rubin A . Ranitidine for erosive oesophagitis: a double-blind, placebo-controlled study. Glaxo Erosive Esophagitis Study Group. Aliment Pharmacol Ther. 1992; 6(5):597-607. DOI: 10.1111/j.1365-2036.1992.tb00574.x. View

Lundell L, Backman L, Ekstrom P, Enander L, Falkmer S, Fausa O . Prevention of relapse of reflux esophagitis after endoscopic healing: the efficacy and safety of omeprazole compared with ranitidine. Scand J Gastroenterol. 1991; 26(3):248-56. DOI: 10.3109/00365529109025038. View

Dehn T, Shepherd H, Colin-Jones D, Kettlewell M, Carroll N . Double blind comparison of omeprazole (40 mg od) versus cimetidine (400 mg qd) in the treatment of symptomatic erosive reflux oesophagitis, assessed endoscopically, histologically and by 24 h pH monitoring. Gut. 1990; 31(5):509-13. PMC: 1378563. DOI: 10.1136/gut.31.5.509. View

Klinkenberg-Knol E, Festen H, Meuwissen S . Pharmacological management of gastro-oesophageal reflux disease. Drugs. 1995; 49(5):695-710. DOI: 10.2165/00003495-199549050-00005. View

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

10.

Galmiche J, Brandstatter G, Evreux M, Hentschel E, Kerstan E, Kratochvil P . Combined therapy with cisapride and cimetidine in severe reflux oesophagitis: a double blind controlled trial. Gut. 1988; 29(5):675-81. PMC: 1433664. DOI: 10.1136/gut.29.5.675. View

11.

Fellenius E, Berglindh T, Sachs G, OLBE L, Elander B, Sjostrand S . Substituted benzimidazoles inhibit gastric acid secretion by blocking (H+ + K+)ATPase. Nature. 1981; 290(5802):159-61. DOI: 10.1038/290159a0. View

12.

VANTRAPPEN G, Rutgeerts L, Schurmans P, Coenegrachts J . Omeprazole (40 mg) is superior to ranitidine in short-term treatment of ulcerative reflux esophagitis. Dig Dis Sci. 1988; 33(5):523-9. DOI: 10.1007/BF01798351. View

13.

Bate C, Booth S, Crowe J, Taylor M, Richardson P . Does 40 mg omeprazole daily offer additional benefit over 20 mg daily in patients requiring more than 4 weeks of treatment for symptomatic reflux oesophagitis?. Aliment Pharmacol Ther. 1993; 7(5):501-7. DOI: 10.1111/j.1365-2036.1993.tb00125.x. View

14.

Fennerty M, Castell D, Fendrick A, Halpern M, Johnson D, Kahrilas P . The diagnosis and treatment of gastroesophageal reflux disease in a managed care environment, Suggested disease management guidelines. Arch Intern Med. 1996; 156(5):477-84. View

15.

Baldi F, Bianchi Porro G, Dobrilla G, Iascone C, Lobello R, Marzio L . Cisapride versus placebo in reflux esophagitis. A multicenter double-blind trial. J Clin Gastroenterol. 1988; 10(6):614-8. DOI: 10.1097/00004836-198812000-00007. View

16.

Tytgat G, Anker Hansen O, Carling L, de Groot G, Geldof H, Glise H . Effect of cisapride on relapse of reflux oesophagitis, healed with an antisecretory drug. Scand J Gastroenterol. 1992; 27(3):175-83. DOI: 10.3109/00365529208999945. View

17.

Richter J . Surgery for reflux disease: reflections of a gastroenterologist. N Engl J Med. 1992; 326(12):825-7. DOI: 10.1056/NEJM199203193261209. View

18.

Hunt R . The relationship between the control of pH and healing and symptom relief in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 1995; 9 Suppl 1:3-7. DOI: 10.1111/j.1365-2036.1995.tb00777.x. View

19.

Masci E, Testoni P, Passaretti S, Guslandi M, TITTOBELLO A . Comparison of ranitidine, domperidone maleate and ranitidine + domperidone maleate in the short-term treatment of reflux oesophagitis. Drugs Exp Clin Res. 1985; 11(10):687-92. View

20.

Zeitoun P, Rampal P, Barbier P, Isal J, Eriksson S, Carlsson R . [Omeprazole (20 mg daily) compared to ranitidine (150 mg twice daily) in the treatment of esophagitis caused by reflux. Results of a double-blind randomized multicenter trial in France and Belgium]. Gastroenterol Clin Biol. 1989; 13(5):457-62. View