A randomized blinded comparison of omeprazole and ranitidine in the treatment of chronic esophageal stricture secondary to acid peptic esophagitis.
BACKGROUND
Esophageal strictures due to gastroesophageal reflux disease are often resistant to medical therapy and require repeated dilation procedures. Our aim was to compare the efficacy of therapy with omeprazole (20 mg/day) to ranitidine (150 mg twice daily) in the treatment of chronic esophageal strictures.


METHODS
Thirty-three patients with chronic esophageal stricture disease (mean length of prior treatment, 50.9 months) were entered into a randomized blinded trial. The majority (88%) of the patients had received multiple prior esophageal dilations (mean, 7.9 per patient). Endoscopy and barium esophagograms were performed initially and at the end of 10 months. Symptoms were considered every 2 months and dilations performed as needed. The patient groups were equivalent.


RESULTS
One patient in each group was subsequently lost to follow-up. No significant differences were seen in symptom improvement or need of dilation. At the final endoscopy, 8 of 17 (47%) patients receiving ranitidine had residual erosions or ulceration, compared with 1 of 14 (7%) patients receiving omeprazole (p >0.2). All patients receiving ranitidine had persistent strictures, whereas 8 of 14 (57.1%) patients receiving omeprazole had radiographic and endoscopic resolution of their strictures (p <0.004).


CONCLUSIONS
These data further emphasize the need for vigorously treating esophagitis in patients with acid peptic strictures.
Silvis
S E
SE
Department of Medicine, University of Minnesota, Minneapolis, USA.
Farahmand
M
M
Johnson
J A
JA
Ansel
H J
HJ
Ho
S B
SB
D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004106:Dilatation; D004940:Esophageal Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D004942:Esophagitis, Peptic / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004947:Esophagus / Q000000981:diagnostic imaging; D006801:Humans; D009853:Omeprazole / Q000627:therapeutic use*; D011859:Radiography; D011899:Ranitidine / Q000627:therapeutic use*
D000897:Anti-Ulcer Agents; D011899:Ranitidine; D009853:Omeprazole