{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T22:58:01Z","timestamp":1765666681175},"reference-count":61,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2005,5,9]],"date-time":"2005-05-09T00:00:00Z","timestamp":1115596800000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2005,5]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold>Background<\/jats:bold> :\u2002There are few data on empiric, stepped therapy for heartburn relief or subsequent relapse in primary care.<\/jats:p><jats:p><jats:bold>Aims<\/jats:bold> :\u2002To compare heartburn relief produced by a proton pump inhibitor\u2010start or an H<jats:sub>2<\/jats:sub>\u2010receptor antagonist\u2010start with step\u2010up therapy, as needed, followed by a treatment\u2010free period to assess relapse.<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold> :\u2002Heartburn\u2010dominant uninvestigated dyspepsia patients from 46 primary care centres were randomized to one of two active treatment strategies: omeprazole 20\u2003mg daily (proton pump inhibitor\u2010start) or ranitidine 150\u2003mg bid (H<jats:sub>2<\/jats:sub>\u2010receptor antagonist\u2010start) for the first 4\u20138\u2003weeks, stepping up to omeprazole 40 or 20\u2003mg daily, respectively, for 4\u20138\u2003weeks for persistent symptoms. Daily diaries documented heartburn relief (score \u22643\/7 on \u22641 of 7 prior days) and relapse (score \u22654 on \u22652 of 7 prior days).<\/jats:p><jats:p><jats:bold>Results<\/jats:bold> :\u2002For \u2018proton pump inhibitor\u2010start\u2019 (<jats:italic>n<\/jats:italic>\u2003=\u2003196) vs. \u2018H<jats:sub>2<\/jats:sub>\u2010receptor antagonist\u2010start\u2019 (<jats:italic>n<\/jats:italic>\u2003=\u2003194), respectively, heartburn relief occurred in 55.1% vs. 27.3% (<jats:italic>P<\/jats:italic>\u2003&lt;\u20030.001) at 4\u2003weeks and in 88.3% vs. 87.1% at 16\u2003weeks. After therapy, 308 patients were heartburn\u2010free (159 vs. 149); median times to relapse were 8 vs. 9\u2003days and cumulative relapse rates were 78.6% vs. 75.8%, respectively.<\/jats:p><jats:p><jats:bold>Conclusions<\/jats:bold> :\u2002An empiric \u2018proton pump inhibitor\u2010start\u2019 strategy relieves heartburn more effectively than an \u2018H<jats:sub>2<\/jats:sub>\u2010receptor antagonist\u2010start\u2019 strategy up to 12\u2003weeks but has no effect on subsequent relapse, which is rapid in most patients.<\/jats:p>","DOI":"10.1111\/j.1365-2036.2005.02466.x","type":"journal-article","created":{"date-parts":[[2005,5,9]],"date-time":"2005-05-09T11:13:08Z","timestamp":1115637188000},"page":"1189-1202","source":"Crossref","is-referenced-by-count":35,"title":["Heartburn\u2010dominant, uninvestigated dyspepsia: a comparison of \u2018PPI\u2010start\u2019 and \u2018H<sub>2<\/sub>\u2010RA\u2010start\u2019 management strategies in primary care \u2013 the CADET\u2010HR Study"],"prefix":"10.1111","volume":"21","author":[{"given":"D.","family":"Armstrong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. 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