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Management of heartburn in a large, randomized, community-based study: comparison of four therapeutic strategies.
Am J Gastroenterol. 2001 Jun; 96(6):1704-10.AJ

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 mg once daily for 20 wk, or ranitidine 150 mg b.i.d. for 8 wk [corrected] 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.

Authors+Show Affiliations

Northwestern University Medical School, Chicago, Illinois, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11419818

Citation

Howden, C W., et al. "Management of Heartburn in a Large, Randomized, Community-based Study: Comparison of Four Therapeutic Strategies." The American Journal of Gastroenterology, vol. 96, no. 6, 2001, pp. 1704-10.
Howden CW, Henning JM, Huang B, et al. Management of heartburn in a large, randomized, community-based study: comparison of four therapeutic strategies. Am J Gastroenterol. 2001;96(6):1704-10.
Howden, C. W., Henning, J. M., Huang, B., Lukasik, N., & Freston, J. W. (2001). Management of heartburn in a large, randomized, community-based study: comparison of four therapeutic strategies. The American Journal of Gastroenterology, 96(6), 1704-10.
Howden CW, et al. Management of Heartburn in a Large, Randomized, Community-based Study: Comparison of Four Therapeutic Strategies. Am J Gastroenterol. 2001;96(6):1704-10. PubMed PMID: 11419818.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of heartburn in a large, randomized, community-based study: comparison of four therapeutic strategies. AU - Howden,C W, AU - Henning,J M, AU - Huang,B, AU - Lukasik,N, AU - Freston,J W, PY - 2001/6/23/pubmed PY - 2001/8/31/medline PY - 2001/6/23/entrez SP - 1704 EP - 10 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 96 IS - 6 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 mg once daily for 20 wk, or ranitidine 150 mg b.i.d. for 8 wk [corrected] 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. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/11419818/Management_of_heartburn_in_a_large_randomized_community_based_study:_comparison_of_four_therapeutic_strategies_ L2 - https://Insights.ovid.com/pubmed?pmid=11419818 DB - PRIME DP - Unbound Medicine ER -