Management of heartburn in a large, randomized, community-based study: Comparison of four therapeutic strategies

Sandeep Gupta, Joseph F. Fitzgerald, Joseph Croffie, Sonny K F Chong, Marian Pfefferkorn, Mary M. Davis, Philip R. Faught

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

OBJECTIVE: Our objective was to compare four management strategies for heartburn: therapy with an H2-receptor antagonist (ranitidine), therapy with a proton pump inhibitor (lansoprazole), crossover from ranitidine to lansoprazole ("step-up" therapy), and crossover from lansoprazole to ranitidine ("step-down" therapy). METHODS: This was a controlled, double-blind, multicenter trial comprising 593 adults with heartburn, randomized to one of four groups for 20 wk. Subjects received either ranitidine 150 mg b.i.d. for 20 wk, or lansoprazole 30 b.i.d. for 8 wk followed by lansoprazole 30 mg once daily for 12 wk ("step-up"), or lansoprazole 30 mg once daily for 8 wk followed by ranitidine 150 mg b.i.d. for 12 wk ("step-down"). Outcome measures were based on self-reports in daily diaries of 24-h heartburn severity, measured by maximum daytime and nighttime severity, and percentage of 24-h heartburn-free days measured by absence of both daytime and nighttime heartburn. RESULTS: Median heartburn severity was significantly lower (p < 0.05) for lansoprazole (0.25) than the other groups (0.46 ranitidine, 0.44 "step-up", 0.35 "step-down"). The lansoprazole group had a significantly higher percentage of 24-h heartburn-free days (median 81.4%, p < 0.01) than other groups (66.6, 66.9, and 73.6%, respectively). In the "step-up" and "step-down" groups, heartburn was less severe, and percentages of 24-h heartburn-free days were higher during lansoprazole treatment regardless of treatment sequence. CONCLUSION: Proton pump inhibitor treatment provides more consistent heartburn relief than an H2-receptor antagonist, or "step-up" or "step-down" therapy.

Original languageEnglish
Pages (from-to)1704-1710
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume96
Issue number6
DOIs
StatePublished - 2001

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Heartburn
Lansoprazole
Ranitidine
Therapeutics
Histamine H2 Receptors
Proton Pump Inhibitors
Self Report
Multicenter Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Management of heartburn in a large, randomized, community-based study : Comparison of four therapeutic strategies. / Gupta, Sandeep; Fitzgerald, Joseph F.; Croffie, Joseph; Chong, Sonny K F; Pfefferkorn, Marian; Davis, Mary M.; Faught, Philip R.

In: American Journal of Gastroenterology, Vol. 96, No. 6, 2001, p. 1704-1710.

Research output: Contribution to journalArticle

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title = "Management of heartburn in a large, randomized, community-based study: Comparison of four therapeutic strategies",
abstract = "OBJECTIVE: Our objective was to compare four management strategies for heartburn: therapy with an H2-receptor antagonist (ranitidine), therapy with a proton pump inhibitor (lansoprazole), crossover from ranitidine to lansoprazole ({"}step-up{"} therapy), and crossover from lansoprazole to ranitidine ({"}step-down{"} therapy). METHODS: This was a controlled, double-blind, multicenter trial comprising 593 adults with heartburn, randomized to one of four groups for 20 wk. Subjects received either ranitidine 150 mg b.i.d. for 20 wk, or lansoprazole 30 b.i.d. for 8 wk followed by lansoprazole 30 mg once daily for 12 wk ({"}step-up{"}), or lansoprazole 30 mg once daily for 8 wk followed by ranitidine 150 mg b.i.d. for 12 wk ({"}step-down{"}). Outcome measures were based on self-reports in daily diaries of 24-h heartburn severity, measured by maximum daytime and nighttime severity, and percentage of 24-h heartburn-free days measured by absence of both daytime and nighttime heartburn. RESULTS: Median heartburn severity was significantly lower (p < 0.05) for lansoprazole (0.25) than the other groups (0.46 ranitidine, 0.44 {"}step-up{"}, 0.35 {"}step-down{"}). The lansoprazole group had a significantly higher percentage of 24-h heartburn-free days (median 81.4{\%}, p < 0.01) than other groups (66.6, 66.9, and 73.6{\%}, respectively). In the {"}step-up{"} and {"}step-down{"} groups, heartburn was less severe, and percentages of 24-h heartburn-free days were higher during lansoprazole treatment regardless of treatment sequence. CONCLUSION: Proton pump inhibitor treatment provides more consistent heartburn relief than an H2-receptor antagonist, or {"}step-up{"} or {"}step-down{"} therapy.",
author = "Sandeep Gupta and Fitzgerald, {Joseph F.} and Joseph Croffie and Chong, {Sonny K F} and Marian Pfefferkorn and Davis, {Mary M.} and Faught, {Philip R.}",
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T1 - Management of heartburn in a large, randomized, community-based study

T2 - Comparison of four therapeutic strategies

AU - Gupta, Sandeep

AU - Fitzgerald, Joseph F.

AU - Croffie, Joseph

AU - Chong, Sonny K F

AU - Pfefferkorn, Marian

AU - Davis, Mary M.

AU - Faught, Philip R.

PY - 2001

Y1 - 2001

N2 - OBJECTIVE: Our objective was to compare four management strategies for heartburn: therapy with an H2-receptor antagonist (ranitidine), therapy with a proton pump inhibitor (lansoprazole), crossover from ranitidine to lansoprazole ("step-up" therapy), and crossover from lansoprazole to ranitidine ("step-down" therapy). METHODS: This was a controlled, double-blind, multicenter trial comprising 593 adults with heartburn, randomized to one of four groups for 20 wk. Subjects received either ranitidine 150 mg b.i.d. for 20 wk, or lansoprazole 30 b.i.d. for 8 wk followed by lansoprazole 30 mg once daily for 12 wk ("step-up"), or lansoprazole 30 mg once daily for 8 wk followed by ranitidine 150 mg b.i.d. for 12 wk ("step-down"). Outcome measures were based on self-reports in daily diaries of 24-h heartburn severity, measured by maximum daytime and nighttime severity, and percentage of 24-h heartburn-free days measured by absence of both daytime and nighttime heartburn. RESULTS: Median heartburn severity was significantly lower (p < 0.05) for lansoprazole (0.25) than the other groups (0.46 ranitidine, 0.44 "step-up", 0.35 "step-down"). The lansoprazole group had a significantly higher percentage of 24-h heartburn-free days (median 81.4%, p < 0.01) than other groups (66.6, 66.9, and 73.6%, respectively). In the "step-up" and "step-down" groups, heartburn was less severe, and percentages of 24-h heartburn-free days were higher during lansoprazole treatment regardless of treatment sequence. CONCLUSION: Proton pump inhibitor treatment provides more consistent heartburn relief than an H2-receptor antagonist, or "step-up" or "step-down" therapy.

AB - OBJECTIVE: Our objective was to compare four management strategies for heartburn: therapy with an H2-receptor antagonist (ranitidine), therapy with a proton pump inhibitor (lansoprazole), crossover from ranitidine to lansoprazole ("step-up" therapy), and crossover from lansoprazole to ranitidine ("step-down" therapy). METHODS: This was a controlled, double-blind, multicenter trial comprising 593 adults with heartburn, randomized to one of four groups for 20 wk. Subjects received either ranitidine 150 mg b.i.d. for 20 wk, or lansoprazole 30 b.i.d. for 8 wk followed by lansoprazole 30 mg once daily for 12 wk ("step-up"), or lansoprazole 30 mg once daily for 8 wk followed by ranitidine 150 mg b.i.d. for 12 wk ("step-down"). Outcome measures were based on self-reports in daily diaries of 24-h heartburn severity, measured by maximum daytime and nighttime severity, and percentage of 24-h heartburn-free days measured by absence of both daytime and nighttime heartburn. RESULTS: Median heartburn severity was significantly lower (p < 0.05) for lansoprazole (0.25) than the other groups (0.46 ranitidine, 0.44 "step-up", 0.35 "step-down"). The lansoprazole group had a significantly higher percentage of 24-h heartburn-free days (median 81.4%, p < 0.01) than other groups (66.6, 66.9, and 73.6%, respectively). In the "step-up" and "step-down" groups, heartburn was less severe, and percentages of 24-h heartburn-free days were higher during lansoprazole treatment regardless of treatment sequence. CONCLUSION: Proton pump inhibitor treatment provides more consistent heartburn relief than an H2-receptor antagonist, or "step-up" or "step-down" therapy.

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