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Update in Gastroenterology
- 1998-99 Series; John Roberts, MD, Editor From University of Kansas Medical Center, Kansas City, Kansas. For the current author address, see end of text. Requests for Reprints: Norton J. Greenberger, MD, Department of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160; e-mail, ngreenbe@kumc.edu. Current Author Addresses: Dr. Greenberger: Department of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160.
In 1997, advances in gastroenterology focused primarily on six areas: gastroesophageal reflux disease, peptic ulcer disease, the diagnosis of appendicitis, the causes and treatment of various kinds of diarrhea, the prevention of colon and anal cancer, and the detection of acute pancreatitis and treatment of its complications.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) affects 7% of the U.S. population each day. Another 29% of this population has symptoms of heartburn weekly to monthly. Americans spend $2 billion per year for over-the-counter H2-blockers and antacids and another $6 billion per year on prescription H2-blockers and proton-pump inhibitors. Yet only a small proportion of persons with GERD seek help from physicians. Endoscopic evidence of esophagitis is found in about 2% of patients with symptoms of GERD but in approximately 10% to 15% of the subset of patients with these symptoms who are referred to gastroenterologists.
Proton-Pump Inhibitors Sped Healing Rate
Chiba N, De Gara CJ, Wilkinson JM, et al. Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis. Gastroenterology. 1997; 112:1798-810.
In assessing GERD, it has been shown that about 25% of patients with endoscopic evidence of esophagitis heal with placebo. Therapy with H2-blockers increases that proportion to about 50%, and proton-pump inhibitors increase it to about 80%. These percentages are often incorrectly called the “healing rate.” For patients, the critical product of therapy is the speed of healing and symptom relief, which reflects a true rate: healing over a given period of time. How rapidly various agents relieve symptoms and heal lesions on endoscopy has not been known, especially in patients with higher grades of esophagitis, which are more resistant to therapy.
This meta-analysis attempted to compare different drug classes with respect to the speed of healing and symptom relief. The authors found 43 studies …
