Correspondence
Maintenance Therapies for Reflux Esophagitis
N Engl J Med 1996; 334:600-601February 29, 1996
- Article
To the Editor:
Vigneri et al. (Oct. 26 issue)1 compared five maintenance therapies for reflux esophagitis but did not comment on their costs. In addition, there is no mention of the way compliance was measured in any of the groups. In the discussion, the authors note that ranitidine plus cisapride might be an alternative to omeprazole but for the issue of compliance (because of the number of pills that must be taken each day). Could the authors address this issue within the context of their own study? Is it possible that some of the differences may relate to better compliance with a medication taken once a day (omeprazole) than with one taken three times a day (ranitidine, cisapride)?
1 ReferencesMichael R. Grey, M.D., M.P.H.
University of Connecticut School of Medicine, Farmington, CT 060301
Vigneri S ,Termini R ,Leandro G , et al. A comparison of five maintenance therapies for reflux esophagitis. N Engl J Med 1995;333:1106-1110
Full Text | Web of Science | Medline
To the Editor:
The authors state that “the combination of cisapride with ranitidine or omeprazole is attractive and rational,” yet their data do not appear to support this conclusion. Specifically, there was no statistical difference in the number of patients in endoscopic remission at 12 months between the cisapride-plus-omeprazole group (89 percent) and the omeprazole group (80 percent). Given these data, in conjunction with concern about both patient compliance and medication cost, the addition of cisapride to omeprazole in the maintenance therapy of reflux esophagitis would appear neither rational nor attractive.
Joseph C. Yarze, M.D.
Gastroenterology Associates of Northern New York, Glens Falls, NY 12801Author/Editor Response
The authors reply:
To the Editor: In response to Dr. Grey: The compliance was checked during follow-up visits and between visits by telephone. Because only two patients (1 percent) were found to be noncompliant, we do not believe that the differences we observed relate to differences in compliance.
In response to Dr. Yarze: We stated that “the combination of cisapride with ranitidine or omeprazole is attractive and rational” because with the two drugs the two main pathophysiologic mechanisms of gastroesophageal reflux disease might be modified. However, our results did not support the hypothesis that these drug combinations are more effective than omeprazole alone, as we stated clearly in the Discussion.
Sergio Vigneri, M.D.
Rosanna Termini, M.D.
Giovanni Davi, M.D.
Institute of Internal Medicine and Geriatrics, 90127 Palermo, Italy
