Table 4.
Acid treatment: drug schedule, and dose.
| Characteristic | Number (% Total) |
|---|---|
| I. Treatment schedule | |
| I.A. First acid medical drug treatment (n = 175) (a) | |
| H2R | 130 (74%) |
| PPI | 45 (26%) |
| I.B. Total acid treatment: drug (n = 175) (a) | |
| H2R-related | |
| H2R antagonist (cimetidine, ranitidine, famotidine, and nizatidine) at any time | 130 (74%) |
| Only H2R antagonists without any PPI treatment at any time | 6 (3.4%) |
| H2R with an anticholinergic agent at any time (b) | 16 (9.1%) |
| H2R without an anticholinergic agent at any time | 158 (90%) |
| H2R followed by PPI (c) | 124 (71%) |
| PPI-related | |
| PPI (omeprazole, lansoprazole, and pantoprazole) at any time | 169 (96.5%) |
| PPI only | 45 (26%) |
| PPI followed by H2R (d) | 3 (1.7%) |
| II. Antisecretory drugs used at any time (a and e) | |
| II.A. H2R (a and e) | |
| Cimetidine | 44 (25%) |
| Ranitidine | 108 (62%) |
| Famotidine | 18 (10%) |
| Nizatidine | 3 (1.7%) |
| II.B. PPI (a and e) | |
| Omeprazole | 168 (96%) |
| Lansoprazole | 26 (15%) |
| Pantoprazole/esomeprazole | 4 (2.2%) |
| III. Treatment: acid secretory drug dose | |
| III.A. Initial antisecretory treatment | |
| H2R (f) | |
| # of patients | 128 |
| Initial dose (mg/day) | |
| Mean ± SEM | 918 ± 86 |
| (Range) | (100–4800) |
| PPI | |
| # of patients | 170 |
| Initial dose (mg/day) (g) | |
| Mean ± SEM | 71.4 ± 3.0 |
| (Range) | (20–240) |
| III.B. Current study: antisecretory drug dose | |
| H2R | |
| # of patients | 9 |
| current dose (mg/day) (f) | |
| Mean ± SEM | 1083 ± 391 |
| (Range) | (300–3600) |
| PPI | |
| # of patients | 166 |
| Current dose (mg/day) (g) | |
| Mean ± SEM | 61.7 ± 3.0 |
| (Range) | (20–240) |
Abbreviations; H2R—Histamine H2-receptor antagonists; PPI—Proton pump inhibitors; ZES—Zollinger–Ellison syndrome. (a) In the NIH perspective trials [106,214], H2Rs were the first effective acid antisecretory medical therapy, with cimetidine first used in 1978, ranitidine in 1982, and famotidine in 1983 [198,226,227]. PPIs were first used in 1983 with omeprazole and then with lansoprazole in 1989 [106,197,220,228]; so, all patients initially enrolled in this study were first treated with H2Rs (cimetidine, ranitidine, and famotidine) and later, most of them switched to PPIs (omeprazole and lansoprazole). New patients generally started treatment with PPIs [106,229]. (b) When only H2R antagonists were available, many patients required high and frequent dosing to control the acid hypersecretion [177,226,227]. The addition of an anticholinergic drug such as isopropamide or probanthine potentiated the H2R inhibitory effect and was thus frequently added [106,230]. (c) Patients with active disease were initially treated with H2Rs and then switched to PPIs as described previously [106]. (d) Patients with active disease were initially treated with PPIs and then switched to H2Rs, particularly after curative resections [169,225]. (e) The total number of patients treated with a given PPI or H2R in total was greater than the number of patients initially treated with PPIs/H2Rs because many of them received more than one antisecretory drug over time. (f) The daily H2R dosage is listed as a ranitidine-equivalent dose calculated as described previously [106,227] using their relative potencies of famotidine/ranitidine/cimetidine of 1:9:32 based on a previous study on ZES patients [227]. (g) The PPI dose listed is listed as a daily omeprazole-equivalent dose as described previously from data demonstrating that omeprazole (20 mg) was equivalent to 40 mg of esomeprazole, 30 mg of lansoprazole, 40 mg of pantoprazole, and 20 mg of rabeprazole [231].