Meta‐analysis of randomized controlled trials comparing standard clinical doses of omeprazole and lansoprazole in erosive oesophagitis

Abstract

Proton pump inhibitors are the drugs of choice for the treatment of erosive oesophagitis. In comparative clinical trials and in meta-analyses, they have been shown to be superior to H 2 -receptor antagonists in healing oesophageal erosions and in relieving associated symptoms. 1 For the different classes of antisecretory drugs, there is a statistically signi®cant linear relationship between suppression of 24-h intragastric acidity and oesophagitis healing rates. 2 In one comparative pharmacodynamic study, lansoprazole 30 mg o.d. produced a quantitatively greater degree of suppression of intragastric acidity than omeprazole 20 mg. 3 These doses of the two drugs are typically used in the treatment of erosive oesophagitis. Through the metaanalysis of randomized controlled trials, we wanted to determine whether the putative superior antisecretory effect of lansoprazole had been translated into a demonstrable advantage in healing rates. MATERIALS AND METHODSUsing the MEDLINE and EMBASE databases, two of the authors independently performed fully recursive literature searches for randomized controlled trials comparing omeprazole and lansoprazole in erosive oesophagitis. We used`omeprazole',`lansoprazole', and`oesophagitis' as text words and key words in the SUMMARY Background: Omeprazole and lansoprazole are used to treat erosive oesophagitis in the respective daily doses of 20 and 30 mg. Aim: To investigate, by meta-analysis, whether treatment with lansoprazole 30 mg increases erosive oesophagitis healing rates over omeprazole 20 mg. Methods: We searched for randomized, double-blind trials comparing omeprazole 20 mg and lansoprazole 30 mg in endoscopically diagnosed erosive oesophagitis. After assessing for homogeneity, non-heterogeneous trials were combined and pooled healing rates derived. We calculated the relative bene®t increase, absolute bene®t increase and number needed to treat.

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

“…15 Importantly, the rate of symptom resolution in EE patients receiving standard dose PPI was 10-15% lower than the observed healing rate of esophageal inflammation. 13,18 Consequently, patients with EE receiving standard dose PPIs may still suffer from heartburn or regurgitation despite a complete resolution of the esophageal inflammation. 19 Moreover, even when continuing the initial healing dose as maintenance treatment for a period of 6 months, 15-23% of the patients with LA-A or LA-B, respectively, and 24-41% with LA-C or LA-D, respectively, relapsed while on treatment.…”

The Clinical Importance of Proton Pump Inhibitor Pharmacokinetics

“…After 8 weeks, there was a trend for superiority of pantoprazole over lansoprazole with 90 and 86% healing rates, respectively. A recent meta-analysis demonstrated that lansoprazole 30 mg is significantly faster than omeprazole 20 mg in healing reflux esophagitis [63, 87]. Rabeprazole 20 mg is as effective as omeprazole 20 mg in healing and preventing recurrence of erosive esophagitis, but may provide more rapid symptom relief [6].…”

Pathogenesis of Double-Dose Proton Pump Inhibitor-Resistant Non-Erosive Reflux Disease, and Mechanism of Reflux Symptoms and Gastric Acid Secretion-Suppressive Effect in the Presence or Absence of <b><i>Helicobacter pylori </i></b>Infection

“…Most patients with reflux esophagitis (RE) with mucosal break are cured of this condition by a standard dose of proton pump inhibitor (PPI), excluding a few of those with severe RE [1,2]. In contrast, about half of non-erosive reflux disease (NERD) patients who have reflux symptoms (heartburn, regurgitation) without mucosal break are PPI-resistant NERD, and do not show improvement with a standard dose of PPI [2,3].…”