Symptomatic gastro-oesophageal reflux disease: double blind controlled study of intermittent treatment with omeprazole or ranitidine
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7182.502 (Published 20 February 1999) Cite this as: BMJ 1999;318:502
All rapid responses
Sir,
I refer to other recent articles in the BMJ as follows:
1998:317:1606-1607 (12 Dec)"Proton Pump Inhibitors may mask early
gastric cancer" 1999:318:827 Reflux "increases risk of adenocarcinoma of oesophagus"
I presume that the treatment with omeprazole is supplemented by
regular endoscopy?
Gwen Harlow
Humberside Oesophageal Support Group
Competing interests: No competing interests
Dr Bardhan and colleagues are to be congratulated on their elegant
study. However I suspect there may still be a role for ranitidine in the
long term management of GERD. The authors did not state how many subjects
in each group did not achieve symptomatic relief by the end of the first
month? This data would allow calculation of the likelihood that a patient
satisfactorily controlled on a given drug at one month, could be
successfully managed with intermittent therapy for one year. Given the
difference in cost between ranitidine and protein pump inhibitors (15 fold
difference in the USA), if we could identify a sub-group of patients with
GERD who could be managed with ranitidine, substantial savings could be
realised.
Competing interests: No competing interests
As a professional writer, employed by a drug company, I am always
interested to see how other companies cope with the problems of
acknowledging the huge numbers of people involved with complex clinical
trials. The paper from Bardhan et al provides a useful example of why the
ICMJE (Vancouver Group) criteria for authorship are often impossible to
apply, and why the move by journals such as the BMJ towards listing
contributions is to be applauded. Anyone who thinks the ICMJE criteria
should be strictly applied ought to read the 'Contributors' section to
understand the difficulties. It is also refreshing to see company
employees featuring prominently in the list of authors.I am also pleased
to see an explicit reference to the use of the CONSORT guidelines and the
note about an earlier presentation of the data.
I am currently working with several pharmaceutical companies to develop
some guidelines on reporting clinical trials (including the thorny issue
of authorship). I should be delighted to hear from people within the
industry who share our aim of improving the quality of such publications
and who would like to be involved with this process.
Competing interests: No competing interests
Side effects on exercise capacity?
The evidence that the proton pump provides the energy for ATP synthesis (Nature 402,17(1999) begs the question of other effects of omeprazole. This possibility has existed since the proton pump inhibitors were introduced but this paper has not sought side effects specifically. It seems likely that there is, for example, impairment of the exercise capacity. A doubly open self-study with n=1 shows a sudden 50% improvement in endurance at maximal effort in swimming the butterfly stroke and it is just possible that the result might be true.
Competing interests: No competing interests