#MEDICATION FOR GORD PLUS#
randomised patients to omeprazole 20 mg once daily, ranitidine hydrochloride (HCl) 150 mg twice daily or ranitidine HCl 150 mg twice daily plus metoclopramide HCl 10 mg 4 times daily.
The administration of PPI and 1 day of H2RA was the only therapy that significantly decreased gastric pH <4 compared to PPI twice daily alone (p < 0.001). analysed 23 healthy volunteers and 20 GORD patients. Twenty-four of 71 patients (34%) required H2RAs, 5 of 71 patients (7%) required prokinetic agents and 11 of 71 patients (15%) remained asymptomatic without medication. Forty-one of 71 patients (58%) were asymptomatic off PPI therapy after 1 year of follow-up. Step-down management of GORD has been investigated. Treatment failure was associated with more than a doubling of antacid use. The use of antacids proved highest in the placebo group and lowest in the omeprazole 20 mg group. Results revealed that after 6 months, the remission rates were 83% (95% CI 77-89) with omeprazole 20 mg, 69% (95% CI 61-77) with omeprazole 10 mg and 56% (95% CI 46-64) with placebo (p < 0.01 for all intergroup differences). The efficacy of on-demand treatment with omeprazole 20 or 10 mg or placebo has also been analysed. The study highlighted that omeprazole was significantly more effective than cisapride (p = 0.02) or ranitidine (p = 0.003), and combination therapy with omeprazole plus cisapride was significantly more effective than cisapride alone (p = 0.003), ranitidine alone (p < 0.001) or ranitidine plus cisapride (p = 0.03).
#MEDICATION FOR GORD TRIAL#
In a trial focused on maintenance therapies for reflux oesophagitis, the study groups were treated with cisapride (10 mg 3 times a day), ranitidine (150 mg 3 times a day), omeprazole (20 mg per day), ranitidine plus cisapride or omeprazole plus cisapride. The findings highlighted that single-dose esomeprazole was at least as effective as twice-daily lansoprazole for the percentage of heartburn-free days (54.4 and 57.5%, respectively). Fifty-four percent dosed sub-optimally with 21 of 54 (39%) dosing more than 60 min before meals.Ī multicentre double-blind trial randomised patients to treatment for 8 weeks with either single-dose esomeprazole (40 mg once daily n = 138) or lansoprazole 30 mg twice daily (n = 144). Their results highlighted that only 46% of patients dosed optimally. assessed optimal PPI dosing and noted that optimal dosers took PPIs with or up to 60 min before meals. The results revealed no statistically significant differences in the mean 24-hour intragastric pH between dosing before dinner or an evening snack compared to breakfast however, there was a small (0.2) but statistically significant difference between lunch and breakfast. performed a randomised study of 48 healthy subjects who received dexlansoprazole MR 60 mg once daily 30 min before meals. All treatments effectively relieved symptoms and were well tolerated. An analysis of 8-week healing of patients with moderate-to-severe oesophagitis demonstrated that dexlansoprazole MR 90 mg was superior to lansoprazole. Week-4 healing was greater than 64% with all treatments. Head of bed elevation and left lateral decubitus position improved the overall time that the oesophageal pH was 0.025).
However, neither tobacco nor alcohol cessation was associated with improvement in oesophageal pH or symptoms. Exposure to tobacco, alcohol, chocolate and high-fat meals decreased lower oesophageal sphincter pressure. screened 2,039 studies and identified trials that examined GORD in relation to lifestyle measures. These include coffee, chocolate, spiced, acidic and heavily fatty foods.
Initial management relies on lifestyle-based improvements including a focus on smoking and alcohol cessation, weight reduction, raising the head of the bed, reduction of eating meals late and reduction of foods that can primarily lead to enhanced reflux occurrence. This review highlights the current evidence in reference to the medical management of GORD. Hence, appropriate management of GORD is needed in order to hinder progression. Survival of oesophageal adenocarcinoma is bleak with an estimated 5-year survival rate of 15%. Evidence suggests that chronic GORD is associated with the development of worsening inflammation, Barrett's oesophagus, dysplasia and, ultimately, adenocarcinoma. Gastro-oesophageal reflux disease (GORD) is rising in prevalence.
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