Clinical Question Which medicatio...

Clinical Question

Which medications improve issues in patients with symptoms of gastroesophageal ebb disease (GERD)who are treated empirically and in those with symptoms nevertheless a normal endoscopy?

Evidence-Based Answer

For empiric treatment of GERD or endoscopy-negative ebb disease, a short trial of a proton interrogate inhibitor increases the chance of remission. Histamine [H.sub.2]-receptor antagonists are les expensive and work well in many patients, particularly those with les strait-laced symptoms or endoscopy-negative reflux disease.

Practice Pointers

GERD is extremely often met with and most patients are treated empirically. Endoscopy can diagnose esophagitis, sore s bleeding, strictures, Barrett 's esophagus, and carcinoma. importunate upper endoscopy should be performed in patients with melena, hematemesis, persistent vomiting, anemia, acute charge of total dysphagia, or involuntary weight los of more than 5 percent of total dead body weight. Patients older than 45 to 50 years should receive nonurgent endoscopy. Younger patients should be considered for endoscopy if they are at risk for gastric cancer. (12) Pinxeren and colleagues reviewed the literature to determine which treatments benefit patients with symptoms of GERD who are treated empirically, and which options are effective in patients with GERD symptoms nevertheless a normal endoscopy.

The authors originate 27 trials with 8,402 participants ranging from 18 to 79 years of age (mean age,48 years);45 percent of participants were men greatest in number of the trials were of adequate quality. Patients who were treated empirically had a remission in heartburn when they received proton cross-examine inhibitors (relative risk [RR], 037; 95 percent confidence interval [CI], 032 to 0.44)and histamine [H.sub.2]-receptor antagonists (RR 077;95 percent CI, 060 to 099) In direct comparisons, proton cross-examine inhibitors were significantly more effective than histamine [H.sub.2]-receptor antagonists and prokinetics in achieving remission. No significant differences were noted between proton interrogate inhibitors and histamine [H.sub.2]-receptor antagonists in patients with endoscopy-negative ebb disease.

The flows of this study did not identify differences between proton cross-examine inhibitors (such studies are lacking). Because many patients do well with a histamine [H.sub.2]-receptor antagonist at to a great degree lower cost, these drugs still should be considered viable treatment options for many patients. The charge difference between the newest proton cross-examine inhibitor (rabeprazole; $4.50 per day) and generic omeprazole (les than $1 by day) or ranitidine (less than $050 by means of day) is substantial.

CLARISSA KRIPKE, MD

Pinxteren B et al. Short-term treatment with proton cross-examine inhibitors, [H.sub.2]-receptor antagonists and prokinetics for gastro-oesophageal ebb disease-like symptoms and endoscopy negative ebb disease. Cochrane Database Syst Rev 2004;(4):CD002095

REFERENCES

(1) Institute for Clinical a whole s Improvement. Dyspepsia and GERD. Bloomington, Minn.: Institute for Clinical classifications Improvement, 2004.

(2) Evaluation of dyspepsia. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology 1998;114:579-81

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