MOHAMMAD FARIVAR, NORWOOD HOSPITAL, ONE LENOX ST, NORWOOD, MA 02062

This is a retrospective review designed to determine omeprazole's effectiveness in healing esophageal mucosal lesions in patients with severe erosive esophagitis who did not respond to other forms of medical treatment.

Materials and Methods: Of seventy consecutive patients with erosive esophagitis that were seen in the office, there were twenty-four patients who were switched to omeprazole due to persistent, severe mucosal lesions (ten with grade-IV, and fourteen with grade-III Savary-Miller classification) in spite of maximal medical treatment. There were fifteen females (33 to 79 years old, averaging 58 years of age) and nine males (31 to 73, averaging 49 years of age). They were followed for a total of 143 patient years (1,715 months), had eighty-six endoscopies, and were treated as follows (prior to switching to omeprazole): three patients received usual dose of H2 receptor antagonists (ranitidine 150 mg p.o. bid or its equivalent plus antacids), ten patients received maximal dose of H2 receptor antagonists (ranitidine 150 mg p.o. qid or its equivalent), and eleven patients received maximal dose H2 receptor antagonists plus metoclopramide (10 mg p.o. qid) and four of eleven received additional sucralfate (1 g qid).

Omeprazole was started at 20 mg p.o. daily and adjusted to 40 mg daily or 20 mg every other day to make patients asymptomatic, or to heal persistent mucosal lesions. In patients with regurgitation, nausea or post-prandial bloating, cisapride (10-20 mg p.o. at bedtime) was added. The patients were followed for a total of 199 months on omeprazole (one to twenty-two months) and had thirty-six follow-up endoscopies,

Results: Mucosal lesions healed in seventeen patients (71%). Of the seven remaining patients, there was improvement of mucosal injury, three from grade-IV to grade-II, and four patients from grade-III to grade-II or I Savary-Miller classification. In five patients with complete healing of mucosal lesions, when omeprazole was reduced to 20 mg p.o. qod (every other day) erosions reoccurred.

Conclusions: In this group of patients with intractable severe esophagitis who had failed other medical forms of reflux treatment, omeprazole healed mucosal injury in 71% and reduced the severity of mucosal lesions in the remaining patients.