A multicentre randomised trial to compare the efficacy of omeprazole versus rabeprazole in early symptom relief in patients with reflux esophagitis

Abstract

BackgroundProton pump inhibitors (PPIs) are affected by cytochrome P450 2C19 (CYP2C19) polymorphisms. This study compared the effect of two PPIs on early symptom relief in Japanese patients with reflux esophagitis, classified by the CYP2C19 phenotype.MethodsPatients with reflux esophagitis were randomised to treatment with omeprazole 20 mg or rabeprazole 10 mg once daily. The CYP2C19 phenotype [homozygous extensive metaboliser (homoEM), heterozygous extensive metaboliser (heteroEM) or poor metaboliser (PM)] of each patient was determined. The primary efficacy endpoint was early, sufficient (Global Overall Symptom scale score 1 or 2), sustained (maintained for ≥7 days) reflux symptom relief.ResultsOf the 199 patients included in this analysis, the proportion achieving sufficient, sustained reflux symptom relief was higher with omeprazole than with rabeprazole on day 1 (35.6 vs. 22.4 %; p = 0.041) and day 2 (43.6 vs. 28.6 %; p = 0.028); there was no significant difference between the two groups on days 3–7. Among patients with the CYP2C19 PM phenotype, sufficient, sustained reflux symptom relief was higher with omeprazole than with rabeprazole on days 4–7 (62.5–66.9 vs 31.6 %; p ≤ 0.03); differences were not significant on days 1–3, or among those with the homoEM or heteroEM phenotypes on days 1–7.ConclusionsIn Japanese patients with reflux esophagitis, omeprazole 20 mg is more effective than rabeprazole 10 mg at achieving early, sufficient, sustained reflux symptom relief in individuals with the CYP2C19 PM phenotype, and is similarly effective to rabeprazole 10 mg in those with heteroEM or homoEM phenotypes.

Rapid metabolizer genotype of CYP2C19 is a risk factor of being refractory to proton pump inhibitor therapy for reflux esophagitis

“…26,28,31 One report only examined patients with NERD, 23 and three included both patients with NERD and those with RE. 27,29,30 Eight reports, covering 11 studies, evaluated the efficacy of PPI treatment of GERD-related symptoms, [23][24][25]27,30,33,35,37 while another eight reports, covering eight studies, assessed cure rate of mucosal breaks using endoscopy. 16,24,28,29,[32][33][34]37 Efficacy rate of proton pump inhibitor treatment against gastroesophageal reflux disease/non-erosive reflux disease.…”

“…Some were evaluated to have efficacy with complete relief of GERD-related symptoms [23][24][25]33,35,37 or endoscopic complete remission with no mucosal break 16,28,29,[32][33][34]37 , and some were evaluated at incomplete improvement of symptoms 27,30 or endoscopic downgrade of severity, not completely 24 . In the studies, we decided efficacy of PPI to improve parts of GERD-related symptoms or endoscopic downgrade of severity.…”

Efficacy of a Potassium-Competitive Acid Blocker for Improving Symptoms in Patients with Reflux Esophagitis, Non-Erosive Reflux Disease, and Functional Dyspepsia

“…Therefore, in addition to healing the esophageal mucosal injury, it is also important to achieve symptomatic relief for GERD. In a multicenter, randomized trial in Japanese patients with RE, the proportions of patients achieving sufficient relief of their reflux symptoms (heartburn and regurgitation) were similar (~80%) in 2 groups who were treated with 20 mg omeprazole and 10 mg rabeprazole, respectively, for 4 weeks (19). In the present study, patients who were administered VPZ as an initial therapy had a relatively high rate of symptomatic improvement (90.9%) in cases of RE, while the rate of improvement in patients with NERD tended to be lower (66.7%).…”

Avaliação Da Qualidade De Cápsulas De Omeprazol Produzidas Em Farmácias Magistrais

“…Entretanto, quando comparados os inibidores da bomba protônica com os antagonistas de receptores H 2 da histamina, os primeiros promovem supressão ácida mais eficaz e prolongada 3 . O primeiro representante dos inibidores da bomba protônica, o Omeprazol, surgiu em 1980 e hoje é considerado o fármaco de primeira escolha para tratamento de pacientes hipersecretores, tais como portadores da Síndrome de Zollinger-Ellison, gastrite crônica e doença do refluxo gastro-esofágico 4 . O Omeprazol inibe a secreção de ácido pela célula parietal através da inibição da enzima H + \K + ATPase, que controla a secreção de H + 5 .…”