Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the Bond and Opera studies).
BACKGROUND
The efficacy of H2-receptor antagonists in functional dyspepsia is equivocal and the therapeutic place of proton pump inhibitors in functional dyspepsia is unknown.


OBJECTIVE
To evaluate the efficacy of proton pump inhibitor therapy in functional dyspepsia.


METHODS
Patients (n = 1262) with a clinical diagnosis of functional dyspepsia (persistent or recurrent epigastric pain or discomfort for at least 1 month and a normal upper gastrointestinal endoscopy) were randomized to receive omeprazole 20 mg, 10 mg or identical placebo, for 4 weeks. Symptoms were assessed using validated measures. Helicobacter pylori status was determined pre-entry by a 13C-urea breath test.


RESULTS
On an intention-to-treat analysis (n=1248), complete symptom relief was observed in 38% on omeprazole 20 mg, compared with 36% on omeprazole 10 mg and 28% on placebo (P = 0.002 and 0.02, respectively). Among those with ulcer-like and reflux-like dyspepsia, complete symptom relief was achieved in 40% and 54% on omeprazole 20 mg, and 35% and 45% on omeprazole 10 mg, respectively, compared with 27% and 23% on placebo (all P < 0.05, except omeprazole 10 mg in ulcer-like dyspepsia, P = 0.08). There was no significant benefit of omeprazole over placebo in dysmotility-like dyspepsia. Symptom relief was similar in H. pylori-positive and negative cases.


CONCLUSIONS
Omeprazole is modestly superior to placebo in functional dyspepsia at standard (20 mg) and low doses (10 mg) but not in patients with dysmotility-like dyspepsia.
Talley
N J
NJ
Department of Medicine, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia. ntalley@blackburn.med.usyd.edu.au
Meineche-Schmidt
V
V
Paré
P
P
Duckworth
M
M
Räisänen
P
P
Pap
A
A
Kordecki
H
H
Schmid
V
V
D000251:Adenosine Triphosphatases / Q000037:antagonists & inhibitors*; D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D004311:Double-Blind Method; D004415:Dyspepsia / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D009853:Omeprazole / Q000627:therapeutic use*; D011788:Quality of Life
D000897:Anti-Ulcer Agents; D000251:Adenosine Triphosphatases; D009853:Omeprazole