The management of acid‐related dyspepsia in general practice: a comparison of an omeprazole versus an antacid‐alginate/ranitidine management strategy

Abstract

Background: There is need for an evidence‐based comparison of clinical management strategies to provide the rationale for selection of a particular therapeutic approach to treatment. Ideal dyspepsia treatment should quickly and conveniently alleviate patient symptoms whilst also minimizing the use of healthcare resources. Aim: To examine dyspepsia symptom relief over 16 weeks and compare an omeprazole clinical management strategy with a commonly used combination of antacid–alginate followed by H₂‐antagonist. Methods: Seven hundred and twenty‐five patients participated in this randomized, open, parallel group comparison over 16 weeks. Patients were randomized to receive either an omeprazole treatment strategy (363) consisting of omeprazole 10 mg stepping up to 20 mg and 40 mg as required, or an antacid–alginate/ranitidine treatment strategy (362) consisting of antacid–alginate 10 mL q.d.s. stepping up to ranitidine 150 mg b.d. and 150 mg q.d.s. as required. Results: A greater proportion of patients receiving the omeprazole clinical management strategy had achieved the stringent health target of complete symptom relief (61 vs. 40%, P < 0.0001) at 16 weeks. Forty‐six per cent of omeprazole‐treated patients were symptom free after the first 10 mg step compared to only 17% in the antacid–alginate treated group (P = 0.0001). Total relief of heartburn, the most common symptom at entry, was achieved by more patients in the omeprazole treatment group than the antacid–alginate/ranitidine treatment group, 62 vs. 36%, respectively, at 4 weeks, and 81 vs. 60% at 16 weeks (P = 0.0001). Conclusion: Treatment with the omeprazole clinical management strategy was superior to the antacid–alginate/ranitidine management strategy in providing relief of acid‐related dyspepsia symptoms after 16 weeks. In addition, the omeprazole treatment strategy involved fewer GP consultations and thus minimized the use of other healthcare resources.