Wasim Jafri  ( Department of Medicine, Aga Khan University Hospital, Karachi. )
Zaigham Abbas  ( Department of Medicine, Aga Khan University Hospital, Karachi. )
Saeed Hamid  ( Department of Medicine, Aga Khan University Hospital, Karachi. )
Hasnain Shah  ( Department of Medicine, Aga Khan University Hospital, Karachi. )
Haleem Khan  ( Department of Medicine, Aga Khan University Hospital, Karachi. )

Omeprazole inhibits the gastric secretion by alter­ing the activity of H + /K+ ATPase^1,2. The drug itself is inactive but is converted to the active form, a sulfonamide in the acid milieu of canaliculi of actively secreting gastric parietal cells³. Though the plasma half life is 60 minutes, the drug binds covalently with H+/K+ATPase and duration of action is thereafter increased to greater than 24 hours⁴. Distal oesophagitis is a complication of gastro-oesophageal reflux. Number and duration of episodes of reflux are important in the pahogenesis^5-7. The aim of this study was to assess the efficacy of omeprazole 20 mg once daily in our patients for short term treatment of refiux oesophagitis.

This was an open labeled, non-comparative single centre study. Outpatients aged 18-70 with endoscopic findings of reflux oesophagitis (grade I to III) were included in the study. Exclusion criteria were pregnant and lactating mothers, treatment with anti-ulcer or anti-refiux drugs within a week prior to inclusion, patients with concomitant gastric or duodenal ulcer, pyloric stenosis, or any malignant lesion as evident on gastroscopy, oesophageal varices, stricture or Barrett’s oesophagus, previous gastro-oesophageal surgery, patients with abnormal renal or hepatic functions and patients requiring regular use of NSAIDs. Before entry, the severity of symptoms and per­sonal habits were assessed. A complete physical examina­tion was performed. Lab investigations including com­plete blood count (CBC), ESR, urinalysis, blood urea nitrogen (BUN), creatinine, biirubin, alanine aminotransferase (ALT) and alkaline phosphatase were done. Endoscopy was performed within a week prior to the inclusion. Informed consent was taken from all the patients. Patients’ symptoms like heart burns and pains were graded from 0 (none) to 3 (severe). Occasional episodes not interfering with the normal activity corresponded to grade 1 (mild), episodes interfering with normal activity as grade 2 (moderate), frequent episodes constantly interfering with normal activity as grade 3 (severe). Oesophagitis was graded as follows: Grade I, erythema, hyperemia or mucosal friability; grade II, superficial erosions; grade III, ulcerations and grade W, complica­tions, e.g., strictures. Patients were seen at two and four weeks to record severity of symptoms and any adverse effects, physical examination and check of left over capsules. Con­comitant use of anti-refiux or other anti-ulcer drugs was forbidden during the study period. Endoscopy was repeated by the same endoscopist at 29±3 days and laboratory tests performed. Thirty consecutive patients were entered in the study. The clinical characteristics and results are sum­marized in


Table I and II and Figure 1 and 2.


Healing defined as complete disappearance of all the lesions and re-epithelization of oesophageal mucosa on endoscopic examination was seen in 19 of 30 patients (68%). Twenty of 30 patients became asymptomatic and another 9 patients improved symptomatically. No major clinical or biochemical side effects were observed. Only one patient complained of some decrease in appetite but he com­pleted the trial.

The randomized clinical trials have proved the superiority of omeprazole over H2 - receptor antagonists^8-13. The healing rate at 4 weeks varied between 67-85% as compared to 27-31% when using ranitidine. Much higher healing rate was observed at 8 weeks with omeprazole; 85-96% with omeprazole vs 38-50% with ranitidine^11-13. There was significantly better symptomatic improvement with omeprazole. Our results are in accordance with the previous studies. We used 20 mg of omeprazole daily and assessed our patients at 4 weeks. The healing rate was 63%. Complete healing was observed in all the cases of grade I oesophagitis and in majority of the patients of grade 11(10 out of 17). The studies indicate that the acid is the major factor in the development of reflux oesophagitis. Omeprazole 20 mg produces 90% reduction in the intragastric acidity whereas 40-60 mg produces 96-98% reduction^14-16. Eleva­tion of gastric pH heals peptic oesophagitis but it does not significantly effect the frequency of postprandial transient lower oesophageal sphincter relaxations and magnitude of basal lower oesophageal sphincter pres­sure^17,18. Also omeprazole has no significant effect on gastric emptying in humans¹⁹.

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