Costo sociale annuo della dispepsia funzionale dopo l'eradicazione dell'Helicobacter pylori : risultati di un'indagine in centri di endoscopia digestiva

Objective: The aim of this study was to evaluate socio-demographic and clinical characteristics of dyspeptic patients in Italy after the eradication of Helicobacter pylori infection and to evaluate the impact of this syndrome on daily activities, on loss of production, and, finally, to estimate its cost for both National Health Service and society. Design: An observational, prospective, one-year, multicenter study was conducted from April 1999 to April 2002 under the aegis of the Italian study group of digestive tract motility (GISMAD). The study was based on 577 consecutive functional dyspeptic patients after eradication of H. pylori. Data were collected by a Case Report Form (CRF). Setting: 91 Centres of Digestive Endoscopy (CED), all located in Italy. Results: The mean age of the 577 dyspeptic patients enrolled in the study was 52 yrs.\ub114 (13.3% was younger than 40 yrs old; mostly females: 56.7%). Sixty point seven percent of patients met expenses related with the treatment of dyspepsia. Patients were stratified into four groups according to their prevalent symptoms: ulcer-like (UL), dismotility-like (DL), reflux-like (RL) and 'other'. Annual mean cost estimated for each patient was \u20ac 145.54, with differences between females and males ( \u20ac 168.95 vs \u20ac 114.91 respectively). "RL" patients resulted at the highest cost (\u20ac 204.32). Total costs were divided into health related costs (\u20ac 60.87) and loss of productivity (\u20ac 84.67), the latter being mostly related absences (21%). Conclusions: During a follow-up period of 12 months, in each group there was a clear evidence of both a reduction of negative influence of dyspeptic symptoms on the patients' activities and a decrease of the mean cost for the treatment of dyspepsia. "RL" group presents cost 30% higher when compared with "UL" and "DL" groups, and 90% higher when compared with "other"

Rabeprazole is equivalent to omeprazole in the treatment of erosive gastro-oesophageal reflux disease. A randomised, double-blind, comparative study of rabeprazole and omeprazole 20 mg in acute treatment of reflux oesophagitis, followed by a maintenance open-label, low-dose therapy with rabeprazole

Background.: Previous studies have shown similar effects of rabeprazole and omeprazole, when used at the same dose in the treatment of reflux oesophagitis. However, such studies have been conducted as superiority studies but interpreted as equivalence ones. Aim.: To properly assess the comparative efficacy of rabeprazole and omeprazole in inducing complete endoscopic healing and symptom relief in patients with reflux oesophagitis. Methods.: Patients (n = 560) with Savary-Miller grade I-III reflux oesophagitis were randomised in a double-blind, double-dummy fashion to rabeprazole or omeprazole 20 mg once daily for 4-8 weeks. Then, patients endoscopically healed and symptomatically relieved were openly maintained with rabeprazole 10 mg or 2 × 10 mg once daily (in the event of clinical and/or endoscopic relapse) for a maximum of 48 weeks. Results.: After 4-8 weeks of treatment, healing (primary end-point) was observed in 228/233 (97.9%) patients in the rabeprazole group and in 231/237 (97.5%) in the omeprazole one (equivalence effect demonstrated by p < 0.0001 at Blackwelder test and an upper confidence limit at 97.5% of 0.023). However, rabeprazole was faster in inducing heartburn relief than omeprazole (2.8 ± 0.2 versus 4.7 ± 0.5 days of therapy to reach the first day with satisfactory heartburn relief, p = 0.0045 at log-rank test). In the maintenance phase, 15.2% of patients had an endoscopic and/or clinical relapse. Conclusion.: Rabeprazole is equivalent to omeprazole in healing reflux oesophagitis, but shows a faster activity on reflux symptoms in the early treatment phase. © 2005 Editrice Gastroenterologica Italiana S.r.l