Skip to main content
NCBI home page
Gut logoLink to Gut
. 1994 Apr;35(4):447–450. doi: 10.1136/gut.35.4.447

Effect of famotidine on oesophageal sensitivity in gastro-oesophageal reflux disease.

J M Marrero 1, J S de Caestecker 1, J D Maxwell 1
PMCID: PMC1374788  PMID: 8174979

Abstract

Gastric acid suppression could improve heartburn by healing oesophagitis or by reduction of oesophageal sensitivity to acid. To independently assess changes in oesophageal sensitivity, it would be necessary to study patients with reflux disease but no oesophagitis. The aim of this study was to investigate the effect of acid suppression on oesophageal sensitivity and to assess the time course of any measured effect. Twenty seven patients were recruited, of whom 25 completed the study (14 men and 11 women, mean (SD) age 50 (15) years). All had classic symptoms of gastro-oesophageal reflux but normal results of upper gastrointestinal endoscopy and oesophageal mucosal histological tests. Each had abnormal 24 hour pH studies and a positive acid perfusion tests. Subjects were assigned double blind to placebo (n = 11) or famotidine 40 mg twice daily (n = 14) for four weeks. Acid perfusion tests were carried out at 0, 4, 5, and 8 weeks and time to heartburn recorded. Time to heartburn (mean (SEM)) was 124 (78) seconds in the famotidine and 187 (154) in the placebo group at week 0 (NS). Compared with baseline, significant increases in time to heartburn was found with famotidine at weeks 4 (383 (102), p < 0.01) and 5 (344 (92), p < 0.01) but not week 8 (336 (90) seconds). No significant effects were found with placebo (219 (41), 146 (23), and 144 (25) seconds for weeks 4, 5, and 8). Heartburn symptom score decreased significantly with famotidine (mean scores 3.6, 1.9, 2.1, and 2.6 at weeks 0, 4, 5, and 8 (p=0.001)) and showed a significant negative correlation with time to heartburn (r(s)=-0.60; p<0.0001). It is concluded that oesophageal sensitivity to acid is reduced by famotidine independent of and effect on oesophagitis; the effect wanes one to four weeks after the end of treatment and correlates with change in heartburn score.

Full text

PDF
447

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Behar J., Brand D. L., Brown F. C., Castell D. O., Cohen S., Crossley R. J., Pope C. E., 2nd, Winans C. S. Cimetidine in the treatment of symptomatic gastroesophageal reflux: a double blind controlled trial. Gastroenterology. 1978 Feb;74(2 Pt 2):441–448. [PubMed] [Google Scholar]
  2. Bell N. J., Hunt R. H. Role of gastric acid suppression in the treatment of gastro-oesophageal reflux disease. Gut. 1992 Jan;33(1):118–124. doi: 10.1136/gut.33.1.118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bessou P., Perl E. R. Response of cutaneous sensory units with unmyelinated fibers to noxious stimuli. J Neurophysiol. 1969 Nov;32(6):1025–1043. doi: 10.1152/jn.1969.32.6.1025. [DOI] [PubMed] [Google Scholar]
  4. Cervero F., Sann H. Mechanically evoked responses of afferent fibres innervating the guinea-pig's ureter: an in vitro study. J Physiol. 1989 May;412:245–266. doi: 10.1113/jphysiol.1989.sp017613. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Haupt P., Jänig W., Kohler W. Response pattern of visceral afferent fibres, supplying the colon, upon chemical and mechanical stimuli. Pflugers Arch. 1983 Jun;398(1):41–47. doi: 10.1007/BF00584711. [DOI] [PubMed] [Google Scholar]
  6. Ismail-Beigi F., Pope C. E., 2nd Distribution of the histological changes of gastroesophageal reflux in the distal esophagus of man. Gastroenterology. 1974 Jun;66(6):1109–1113. [PubMed] [Google Scholar]
  7. Johansson K. E., Tibbling L. Gastric secretion and reflux pattern in reflux oesophagitis before and during ranitidine treatment. Scand J Gastroenterol. 1986 May;21(4):487–492. doi: 10.3109/00365528609015167. [DOI] [PubMed] [Google Scholar]
  8. Johnson L. F., Demeester T. R., Haggitt R. C. Esophageal epithelial response to gastroesophageal reflux. A quantitative study. Am J Dig Dis. 1978 Jun;23(6):498–509. doi: 10.1007/BF01072693. [DOI] [PubMed] [Google Scholar]
  9. Klauser A. G., Schindlbeck N. E., Müller-Lissner S. A. Esophageal 24-h pH monitoring: is prior manometry necessary for correct positioning of the electrode? Am J Gastroenterol. 1990 Nov;85(11):1463–1467. [PubMed] [Google Scholar]
  10. Orr W. C., Robinson M. G., Humphries T. J., Antonello J., Cagliola A. Dose--response effect of famotidine on patterns of gastro-oesophageal reflux. Aliment Pharmacol Ther. 1988 Jun;2(3):229–235. doi: 10.1111/j.1365-2036.1988.tb00692.x. [DOI] [PubMed] [Google Scholar]
  11. Pace F., Santalucia F., Bianchi Porro G. Natural history of gastro-oesophageal reflux disease without oesophagitis. Gut. 1991 Aug;32(8):845–848. doi: 10.1136/gut.32.8.845. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Powell-Jackson P., Barkley H., Northfield T. C. Effect of cimetidine in symptomatic gastro-oesophageal reflux. Lancet. 1978 Nov 18;2(8099):1068–1069. doi: 10.1016/s0140-6736(78)91802-0. [DOI] [PubMed] [Google Scholar]
  13. Robertson D. A., Aldersley M. A., Shepherd H., Lloyd R. S., Smith C. L. H2 antagonists in the treatment of reflux oesophagitis: can physiological studies predict the response? Gut. 1987 Aug;28(8):946–949. doi: 10.1136/gut.28.8.946. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Robinsen M., Decktor D. L., Stone R. C., Pevelery M., Barden P., Moyer R., Holt S., Root J., Hufnagel K., Humphries T. J. Famotidine (20 mg) b.d. relieves gastrooesophageal reflux symptoms in patients without erosive oesophagitis. Famotidine/GERD Investigation Group. Aliment Pharmacol Ther. 1991 Dec;5(6):631–643. doi: 10.1111/j.1365-2036.1991.tb00531.x. [DOI] [PubMed] [Google Scholar]
  15. Schindlbeck N. E., Heinrich C., König A., Dendorfer A., Pace F., Müller-Lissner S. A. Optimal thresholds, sensitivity, and specificity of long-term pH-metry for the detection of gastroesophageal reflux disease. Gastroenterology. 1987 Jul;93(1):85–90. doi: 10.1016/0016-5085(87)90318-0. [DOI] [PubMed] [Google Scholar]
  16. Sladen G. E., Riddell R. H., Willoughby J. M. Oesophagoscopy, biopsy, and acid perfusion test in diagnosis of "reflux oesophagitis". Br Med J. 1975 Jan 11;1(5949):71–76. doi: 10.1136/bmj.1.5949.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Weinstein W. M., Bogoch E. R., Bowes K. L. The normal human esophageal mucosa: a histological reappraisal. Gastroenterology. 1975 Jan;68(1):40–44. [PubMed] [Google Scholar]
  18. de Caestecker J. S., Blackwell J. N., Pryde A., Heading R. C. Daytime gastro-oesophageal reflux is important in oesophagitis. Gut. 1987 May;28(5):519–526. doi: 10.1136/gut.28.5.519. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES