A systematic review 1 including 16 RCTs on gastro-oesophageal reflux disease was abstracted in DARE. According to two meta-analyses, omeprazole is more effective than H2 antagonists, cisapride, sucralfate or placebo for short-term healing of erosions in GORD. 20 mg of omeprazole is more effective than placebo, ranitidine or cisapride in reducing relapses of oesophagitis at 12 months. Omeprazole and lansoprazole are as effective.
Another systematic review 2 including 48 papers reporting 69 clinical trials was abstracted in DARE. There were 5060 participants involved in studies examining efficacy rates and 1525 participants in studies examining relapse rates. Four-week cure rates were higher with omeprazole 20 mg (cure rate 0.625) than with ranitidine 300 mg (cure rate 0.329). After 12 weeks of therapy the cure rate for ranitidine 600 mg/day was 0.811 (95% CI 0.757 to 0.866) and cisapride 40 mg/day was 0.578 (95% CI 0.442 to 0.714). ranitidine 300 mg/day the 12-week cure rate was 0.619 (95% CI 0.502 to 0.735). Omeprazole had the highest cure rates in these trials. For mild GORD, cure rates were 38% with ranitidine 300 mg/day, 56% with cisapride 40 mg/day, 75% with omeprazole 20 mg/day and 82% with cisapride 80 mg/day. The relapse rate at 6 months was lowest with omeprazole (17%) compared to 33% with cisapride and 49% with ranitidine.
Comment: Cisapride should not be used because of the risk for arrhythmias.
Primary/Secondary Keywords