Proportion Of Patients In Remission Research Articles

Omeprazole or ranitidine in long-term treatment of reflux esophagitis

Background/Aims: Patients with reflux esophagitis have rapid relapses after treatment withdrawal. This study was designed to investigate the relapse rate of symptomatic esophagitis during maintenance treatment with omeprazole or ranitidine. Methods: Patients with endoscopically verified acute erosive or ulcerative esophagitis were initially treated with 20–40 mg omeprazole daily for 8–12 weeks. After healing, the patients were randomized to maintenance treatment with omeprazole (20 or 10 mg each morning) or ranitidine (150 mg twice daily). Control endoscopy was performed at the end of the healing phase and after 12 months of maintenance treatment or symptomatic relapse. Results: Of 426 initially treated patients, 392 were healed and entered the maintenance study. The estimated proportions of patients in remission after 12 months of maintenance treatment with 20 mg omeprazole once daily (n = 131), 10 mg omeprazole once daily (n = 133), and 150 mg ranitidine twice daily (n = 128) were 72%, 62%, and 45%, respectively. Both the 10- and 20-mg doses of omeprazole were significantly better than the dose of ranitidine (P < 0.001 and P < 0.005, respectively). There was no significant difference between the 10- and 20-mg doses of omeprazole (P = 0.06). Conclusions: Maintenance treatment with omeprazole (20 or 10 mg once daily) is superior to ranitidine (150 mg twice daily) in keeping patients with erosive reflux esophagitis in remission over a 12-month period.

Prevention of Duodenal Ulcer Relapse by Long-Term Treatment with Omeprazole

Duodenal ulcer is a chronic disease with a high risk of relapse--if left untreated, the relapse rate is 50-80% per year (1). However, the relapse rate can be effectively reduced by inhibition of gastric acid secretion. Although many patients can be managed with episodic therapy, controlled either by the patient or doctor, continuous maintenance treatment is often necessary for patients with severe forms of the disease and those at risk of complications (2). Maintenance therapy with single night-time doses of an H2-receptor antagonist reduces relapse rates from approximately 75% to 25% per year (3). As omeprazole is more effective than the H2-receptor antagonists in the acute treatment of duodenal ulcer, healing virtually all patients within 4 weeks (4), it may also be more effective in the maintenance treatment of duodenal ulcer disease. To date, three studies have reported the effect of omeprazole on relapse rates of duodenal ulcer. A Danish multicentre study involved 195 patients, who were treated with omeprazole, either 10 mg once daily, or 20 mg once daily on Friday, Saturday and Sunday (weekend therapy), or with placebo (5). After 6 months, the remission rates were 67% and 70%, respectively, for those patients receiving omeprazole--significantly higher than in those receiving placebo (17% after 6 months). An Italian multicentre study of 81 patients found that omeprazole, both 10 mg once daily, and 20 mg once daily at weekends (Friday, Saturday and Sunday), was equally effective in preventing relapse. The proportions of patients in remission were 81% and 70%, respectively, after 6 months (6).(ABSTRACT TRUNCATED AT 250 WORDS)

Amoxicillin added to omeprazole prevents relapse in the treatment of duodenal ulcer patients

Objective: To evaluate two different therapies, omeprazole/amoxicillin versus omepra-zole alone, in the treatment of duodenal ulcer patients with respect to eradication of Helicobacter pylori and time in remission during a 6-month follow-up after cessation of therapy. Design: Double-blind, randomized, parallel groups. Setting: Outpatient referrals in nine Swedish centres. Patients: This study included 248 patients with active duodenal ulcer. Main outcome measures: Endoscopic and symptomatic evaluation of time in remission. Culture, histology and serology for determination of H. pylori status. Results: Eradication of H. pylori was 54 compared with 4% and the proportion of patients in remission at 6 months was 70 compared with 36% in the omeprazole/amoxicillin treated group versus the group treated with omeprazole alone. Of the patients who became H. pylori-negative, 84% were in remission throughout the study. Conclusion: H. pylori is an almost obligate prerequisite for duodenal ulcer disease. Amoxicillin added to omeprazole nearly doubled the proportion of patients in remission at 6 months follow-up. The eradication rate of H. pylori in patients with excellent compliance was 74%.

Epileptic seizures in a population of 6000. II: Treatment and prognosis.

Treatment and prognosis were studied in 122 patients with non-febrile seizures in a population of 6000. Phenytoin and phenobarbitone were the most commonly prescribed drugs, although the popularity of phenobarbitone had declined over time. The average duration of treatment was relatively short, and most patients received single drug treatment. Treatment patterns were erratic, and the surveillance and audit of treatment generally poor. Recurrence after a first attack was found in four fifths of the patients. Generally the total number of seizures suffered by each patient was small, the period of active epilepsy short, and remission when it occurred was usually permanent. The cumulative probability of continuing activity fell and the proportion of patients in remission rose over time. Patients with partial or mixed seizure types had a poorer overall prognosis. The course of the epilepsy in the early years of treatment proved to be a useful guide to the long term prognosis, and the possibility that effective treatment might influence long term prognosis is raised.