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Vitamin E May Improve Omeprazole Treatment of Moderate to Severe Erosive Oesophagitis: Presented at UEGW
By Adrian Burton
MADRID, SPAIN -- November 11, 2003 -- Vitamin E may improve the results of alternate day omeprazole 20 mg maintenance treatment for moderate to severe erosive oesophagitis. This finding was from an Iranian study, presented here November 5th at the 11th United European Gastroenterology Week
Over 80% of patients with moderate to severe erosive oesophagitis relapse on currently available treatment, so improved therapeutic strategies are needed.
"There are studies showing that the mucosal damage in oesophagitis is mediated primarily by free radicals," explained Shahram Mirmomen, MD, Associate Professor in Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran. "And vitamin E has antioxidant properties. This was [our] basis for using vitamin E to increase the mucosal resistance in reflux."
Fifty-eight patients with moderate to severe erosive oesophagitis were enrolled in a double-blind placebo-controlled trial, in which 29 participants received omeprazole 20 mg every other day plus vitamin E 800 mg/day, and 29 received omeprazole 20 mg every other day plus a daily placebo. The groups were age and sex matched. At entry, all patients had been cured of endoscopically confirmed oesophagitis (Grade 2 or 3 on the Los Angeles scale) by anti-secretory therapy.
All patients underwent endoscopic control to assess relapse rates at 24 and 48 weeks, or when they presented with symptoms.
At 24 weeks, 82.8% of the vitamin-E-group patients were still in remission compared to only 58.6% in the placebo group (P = .04). Similarly, at 48 weeks, 79.3% and 55.2% were in remission (P = .04). Further, 68.9% of patients in the vitamin E group were symptom-free, compared to 48.2% in the placebo group.
"This study shows that vitamin E plus low-dose omeprazole is more effective than omeprazole alone for maintenance of moderate to severe osophagitis. But this is a very preliminary study, and I think a larger one is necessary to confirm this," said Dr. Mirmomen.
The results could be of immediate use to physicians treating patients with recurrent oesophagitis, however. Vitamin E is cheap, widely available, safe, and may even help prevent other diseases such as cardiovascular disease, cancer and dementia -- so nothing would be lost by adding it to the treatment regimen.
Such treatment might also allow the dose of proton pump inhibitor used to be lowered.
[Study Title: Combination of Omeprazole 20 mg Every Other Day and Vitamin E in Preventing Endoscopic Relapse of Erosive Esophagitis: A Placebo-Controlled Double-Blind Study. Abstract Wed-OP-G-228]
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