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Heartburn-dominant, uninvestigated dyspepsia: a comparison of 'PPI-start' and 'H2-RA-start' management strategies in primary care--the CADET-HR Study.
Aliment Pharmacol Ther. 2005 May 15; 21(10):1189-202.AP

Abstract

BACKGROUND

There are few data on empiric, stepped therapy for heartburn relief or subsequent relapse in primary care.

AIMS

To compare heartburn relief produced by a proton pump inhibitor-start or an H(2)-receptor antagonist-start with step-up therapy, as needed, followed by a treatment-free period to assess relapse.

METHODS

Heartburn-dominant uninvestigated dyspepsia patients from 46 primary care centres were randomized to one of two active treatment strategies: omeprazole 20 mg daily (proton pump inhibitor-start) or ranitidine 150 mg bid (H2-receptor antagonist-start) for the first 4-8 weeks, stepping up to omeprazole 40 or 20 mg daily, respectively, for 4-8 weeks for persistent symptoms. Daily diaries documented heartburn relief (score < or = 3/7 on < or = of 7 prior days) and relapse (score > or = 4 on > or = 2 of 7 prior days).

RESULTS

For 'proton pump inhibitor-start' (n = 196) vs. 'H2-receptor antagonist-start' (n = 194), respectively, heartburn relief occurred in 55.1% vs. 27.3% (P < 0.001) at 4 weeks and in 88.3% vs. 87.1% at 16 weeks. After therapy, 308 patients were heartburn-free (159 vs. 149); median times to relapse were 8 vs. 9 days and cumulative relapse rates were 78.6% vs. 75.8%, respectively.

CONCLUSIONS

An empiric 'proton pump inhibitor-start' strategy relieves heartburn more effectively than an 'H2-receptor antagonist-start' strategy up to 12 weeks but has no effect on subsequent relapse, which is rapid in most patients.

Authors+Show Affiliations

Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada. armstro@mcmaster.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

15882239

Citation

Armstrong, D, et al. "Heartburn-dominant, Uninvestigated Dyspepsia: a Comparison of 'PPI-start' and 'H2-RA-start' Management Strategies in Primary Care--the CADET-HR Study." Alimentary Pharmacology & Therapeutics, vol. 21, no. 10, 2005, pp. 1189-202.
Armstrong D, Veldhuyzen van Zanten SJ, Barkun AN, et al. Heartburn-dominant, uninvestigated dyspepsia: a comparison of 'PPI-start' and 'H2-RA-start' management strategies in primary care--the CADET-HR Study. Aliment Pharmacol Ther. 2005;21(10):1189-202.
Armstrong, D., Veldhuyzen van Zanten, S. J., Barkun, A. N., Chiba, N., Thomson, A. B., Smyth, S., Sinclair, P., Chakraborty, B., & White, R. J. (2005). Heartburn-dominant, uninvestigated dyspepsia: a comparison of 'PPI-start' and 'H2-RA-start' management strategies in primary care--the CADET-HR Study. Alimentary Pharmacology & Therapeutics, 21(10), 1189-202.
Armstrong D, et al. Heartburn-dominant, Uninvestigated Dyspepsia: a Comparison of 'PPI-start' and 'H2-RA-start' Management Strategies in Primary Care--the CADET-HR Study. Aliment Pharmacol Ther. 2005 May 15;21(10):1189-202. PubMed PMID: 15882239.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Heartburn-dominant, uninvestigated dyspepsia: a comparison of 'PPI-start' and 'H2-RA-start' management strategies in primary care--the CADET-HR Study. AU - Armstrong,D, AU - Veldhuyzen van Zanten,S J O, AU - Barkun,A N, AU - Chiba,N, AU - Thomson,A B R, AU - Smyth,S, AU - Sinclair,P, AU - Chakraborty,B, AU - White,R J, AU - ,, PY - 2005/5/11/pubmed PY - 2005/8/17/medline PY - 2005/5/11/entrez SP - 1189 EP - 202 JF - Alimentary pharmacology & therapeutics JO - Aliment Pharmacol Ther VL - 21 IS - 10 N2 - BACKGROUND: There are few data on empiric, stepped therapy for heartburn relief or subsequent relapse in primary care. AIMS: To compare heartburn relief produced by a proton pump inhibitor-start or an H(2)-receptor antagonist-start with step-up therapy, as needed, followed by a treatment-free period to assess relapse. METHODS: Heartburn-dominant uninvestigated dyspepsia patients from 46 primary care centres were randomized to one of two active treatment strategies: omeprazole 20 mg daily (proton pump inhibitor-start) or ranitidine 150 mg bid (H2-receptor antagonist-start) for the first 4-8 weeks, stepping up to omeprazole 40 or 20 mg daily, respectively, for 4-8 weeks for persistent symptoms. Daily diaries documented heartburn relief (score < or = 3/7 on < or = of 7 prior days) and relapse (score > or = 4 on > or = 2 of 7 prior days). RESULTS: For 'proton pump inhibitor-start' (n = 196) vs. 'H2-receptor antagonist-start' (n = 194), respectively, heartburn relief occurred in 55.1% vs. 27.3% (P < 0.001) at 4 weeks and in 88.3% vs. 87.1% at 16 weeks. After therapy, 308 patients were heartburn-free (159 vs. 149); median times to relapse were 8 vs. 9 days and cumulative relapse rates were 78.6% vs. 75.8%, respectively. CONCLUSIONS: An empiric 'proton pump inhibitor-start' strategy relieves heartburn more effectively than an 'H2-receptor antagonist-start' strategy up to 12 weeks but has no effect on subsequent relapse, which is rapid in most patients. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/15882239/Heartburn_dominant_uninvestigated_dyspepsia:_a_comparison_of_'PPI_start'_and_'H2_RA_start'_management_strategies_in_primary_care__the_CADET_HR_Study_ L2 - https://doi.org/10.1111/j.1365-2036.2005.02466.x DB - PRIME DP - Unbound Medicine ER -