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Comparison of Omeprazole and Famotidine for Controlling GERD Symptoms

Info: 920 words (4 pages) Essay
Published: 17th Mar 2021 in Medical

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Final Question: How does omeprazole compare to famotidine in terms of efficacy in controlling non-erosive gastro-esophageal reflux disease (GERD) symptoms in H. pylori negative adults?

P: Adults with GERD symptoms

I: Omeprazole

C: Famotidine

O: Complete relief of GERD symptoms

Evidence Based Answer:

Omeprazole may be more effective than famotidine with regards to controlling non-erosive GERD symptoms in H. pylori negative patients. (Strength of recommendation = B, based on single prospective randomized controlled trial with patient-oriented outcomes)

Evidence Summary:

A 2005 multi-center prospective randomized controlled trial compared the efficacy of omeprazole to famotidine in controlling symptoms of non-erosive GERD in Japanese patients. 1 The randomized controlled trial included 54 H. pylori negative patients in which 28 patients received omeprazole 20 mg once daily for 4 weeks and 26 patients received famotidine 20 mg twice daily for 4 weeks. The trial included outpatients with non-erosive GERD symptoms. The diagnosis of GERD included heartburn or acid reflux symptoms that took place two times a week or more for at least 1 month. Pregnant and nursing mothers were excluded from the trial. The study indicated that rate of complete relief in the omeprazole group was statistically significant higher than the famotidine group in week 4; in which the omeprazole group had 53.6% complete relief of GERD symptoms while the famotidine group had only 34.5% incidence of complete relief of GERD symptoms (P=0.069). One limitation to the study is that the number of patients included in the trial was very low; further studies with a larger population of patients would be recommended to confirm the difference in efficacy between omeprazole and famotidine in controlling non-erosive GERD symptoms.

Recommendation from Others:

The American College of Gastroenterology (ACG) published guidelines for the diagnosis and treatment of GERD in 2013.2 The quality of evidence was described as low, moderate or high.  Strength of Recommendations was classified as grades where (A) indicates Strong recommendation, (B) indicates intermediate recommendation, and (C) indicates weak recommendation. According to ACG guidelines, proton pump inhibitors (e.g. omeprazole) once daily dose before first meal should be started for GERD management (Strength of recommendation: Strong, moderate level of evidence).

References:

  1. Fujiwara Y, Higuchi K, Nebiki H, et al. Famotidine vs. omeprazole: a prospective randomized multicentre trial to determine efficacy in non-erosive gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2005;21 Suppl 2:10–18.
  1. Katz PO, Gerson LB, Vela MF, et al. Guidelines for the diagnosis and management of gastro-esophageal reflux disease. American College of Gastroenterology clinical guidelines. Am. J. Gastroenterol. 2013;108(3):308-328.

Search Strategy

PubMed

Abstracts:

  1. Fujiwara Y, Higuchi K, Nebiki H, et al. Famotidine vs. omeprazole: a prospective randomized multicentre trial to determine efficacy in non-erosive gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2005;21 Suppl 2:10–18.

Background: Several studies in Western countries showed that proton-pump inhibitors are superior to histamine2-receptor antagonists or placebo in the treatment of non-erosive gastro-oesophageal reflux disease. The efficacy of acid-suppressive drugs for non-erosive gastro-oesophageal reflux disease in Japan, in which the prevalence of Helicobacter pylori infection is higher compared with Western countries, is unknown. Aim: To compare the efficacy of famotidine and omeprazole in Japanese patients with non-erosive gastro-oesophageal reflux disease by a prospective randomized multicentre trial. Methods: A total of 98 patients received either famotidine 20 mg b.d. (n = 48) or omeprazole once daily (n = 50). Frequency of gastro-oesophageal reflux disease symptoms and health-related quality of life were evaluated at baseline and after 4 weeks of treatment. Complete relief was defined as no gastro-oesophageal reflux disease symptoms during the 7-day interval in week 4. Results: Complete relief was achieved in 23 (48%) of patients receiving famotidine and 28 (56%) of patients treated with omeprazole. In the famotidine group, complete relief rate in H. pylori-negative patients was significantly lower than H. pylori-positive patients (35% vs. 64%). Both famotidine and omeprazole improved most scales of health-related quality of life. Omeprazole significantly improved reflux score irrespective of H. pylori infection while famotidine significantly improved reflux score in H. pylori-positive patients but not in H. pylori-negative patients. Conclusions: Omeprazole is more effective than famotidine for the control of gastro-oesophageal reflux disease symptoms in H. pylori-negative patients, while similar efficacy is observed in H. pylori-positive patients with non-erosive gastro-oesophageal reflux disease.

 

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