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Treatment of Severe Reflux Esophagitis with Cimetidine and Metoclopramide

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Grant support: by grant RR00334 from the General Clinical Research Center Branch of the Division of Research Resources, National Institutes of Health; and in part by funds from A. H. Robins Company, Richmond, Virginia.

▸Requests for reprints should be addressed to David A. Lieberman, M.D.; Portland Veterans Administration Medical Center, P.O. Box 1034; Portland, OR 97207.

Portland, Oregon

Ann Intern Med. 1986;104(1):21-26. doi:10.7326/0003-4819-104-1-21
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Reflux esophagitis may be unresponsive to standard medical therapy with an H2-receptor antagonist drug. Twenty-five patients with chronic reflux esophagitis, refractory to cimetidine treatment alone, were randomly assigned in a double-blind design to receive cimetidine (1200 mg/d), in combination with metoclopramide (40 mg/d) or placebo. Nine of twelve patients receiving cimetidine with metoclopramide had significant symptomatic improvement at the end of the 8-week study period, compared with 3 of 12 patients receiving cimetidine with placebo (p < 0.02). Endoscopic appearance improved in 9 patients receiving metoclopramide and in 4 patients receiving placebo (p < 0.05). Neither group had significant improvement in lower esophageal sphincter pressure, 24-hour esophageal pH recordings, and esophageal histologic findings. Side effects were common with cimetidine and metoclopramide but were rarely disabling. This combination is efficacious in the management of chronic reflux esophagitis but, because of frequent side effects, should be reserved for patients refractory to treatment with cimetidine alone.





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