A comparison of esomeprazole and lansoprazole for control of intragastric pH in patients with symptoms of gastro‐oesophageal reflux disease

Abstract

SUMMARYBackground: Intragastric acid suppression is the most direct measure of the pharmacodynamic efficacy of proton pump inhibitors, which are the most effective drugs for acid-related diseases. Aim: To compare the effectiveness of once and twice daily dosing of lansoprazole and esomeprazole in controlling intragastric acidity (target gastric pH > 4.0) over a 24-hour period. Methods:In an open-label, two-way crossover study, 45 Helicobacter pylori-negative patients with gastro-oesophageal reflux disease were randomized to receive one of two regimens: 30 mg lansoprazole or esomeprazole 40 mg once daily. Intragastric pH was assessed by 24-hour pH monitoring on day 5 of each regimen. Dosing was increased to twice daily and pH was reassessed on day 10. Following a 14-day washout, patients were crossed over to the other medication and the dosage regimens and pH assessments were repeated.

Video-endoscopy for evaluation of columnar lined esophagus in patients with gastroesophageal reflux disease

“…All patients reported heartburn, regurgitation, absence of dysphagia and symptom-relief upon treatment with proton pump inhibitor (esomeprazole 40 mg twice daily for at least 2 weeks) [20].…”

“…Demographic data of patients are depicted in Table 2. In keeping with recommendations published by the American Gastroenterological Association (AGA) [19], all patients were on proton pump inhibitor (PPI) treatment for at least 2 weeks prior to endoscopy (2 x 40 mg esomeprazole daily) [20] for exclusion of inflammatory changes impairing histopathologic diagnosis [7,8,19].…”

Short and long-term PPI treatment for GERD. Do we need more-potent anti-secretory drugs?

“…Data from many studies indicate that the likelihood of esophagitis healing relates directly to the potency of drug antisecretory effect [32][33][34][35]. Hence, a high healing rate has been consistently reported after 4 and 8 weeks standard dose PPI regimen [7].…”

Latin American Consensus on Gastroesophageal Reflux Disease: An Update on Therapy

“…iv) Proton pump inhibitors Overview: PPIs are generally accepted to be significantly more effective than placebo, H 2 -RAs and prokinetics for heartburn relief and general improvement of symptoms in patients without documented erosive esophagitis. Virtually all clinical data are derived from studies using a once-daily PPI and, although there are gastric pH data to show that twice-daily PPIs produce greater acid suppression than oncedaily therapy in patients with GERD symptoms, 27 there are no clinical data on high-dose PPI therapy in this patient group. Heartburn relief with standard dose omeprazole (20 mg daily) was greater than with half-dose omeprazole (10 mg daily) but previous studies have reported no differences between distinct doses of esomeprazole (40 mg and 20 mg) or between esomeprazole (40 mg daily) and omeprazole (20 mg daily).…”