Is esomeprazole the best choice for reflux esophagitis patients?

In patients with gastroesophageal reflux disease (GERD), esomeprazole, has demonstrated pharmacological and clinical benefits beyond those seen with the other proton pump inhibitors (PPIs).

However it has not hitherto been fully determined whether differences in the onset of antisecreatary activity may affect the speed of symptom relief with different PPI.

Dr. Ri-Nan Zheng from China addresses this question. He investigated whether there is any difference in the symptom relief in patients with reflux esophagitis following the administration of four PPIs (omeprazole, lansoprazole, pantoprazole, esomeprazole). This will be published on February 28, 2009 in the World Journal of Gastroenterology.

In this study, two hundred and seventy-four patients with erosive reflux esophagitis were randomized to receive 8 wk of 20 mg omeprazole (n = 68), 30 mg of lansoprazole (n = 69), 40 mg of pantoprazole (n = 69), 40 mg of esomeprazole (n = 68) once a day in the morning. Daily changes in heartburn and acid reflux symptoms in the first 7 d of administration were assessed using a six-point scale (0: none; 1: mild; 2: mild-moderate; 3: moderate; 4: moderate-severe; 5: severe).

He found that the mean heartburn score in patients treated with esomeprazole more rapidly decreased than those receiving other PPI. Complete resolution of heartburn was also more rapid in patients treated with esomeprazole for 5 d compared with omeprazole (P = 0.0018, P = 0.0098, P = 0.0027, P = 0.0137, P = 0.0069, respectively), lansoprazole (P = 0.0020, P = 0.0046, P = 0.0037, P = 0.0016, P = 0.0076, respectively), and pantoprazole (P = 0.0006, P = 0.0005, P = 0.0009, P = 0.0031, P = 0.0119, respectively). There were no significant differences between the four groups in the rate of endoscopic healing of reflux esophagitis at week 8.

The results indicated that esomeprazole may be more effective than omeprazole, lansoprazole, and pantoprazole for the rapid relief of heartburn symptoms and acid reflux symptoms in patients with reflux esophagitis.