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Evidence summaries

Esomeprazole for the Acute Treatment of Reflux Oesophagitis

Esomeprazole 40 mg has demonstrated higher healing rates than omeprazole 20 mg in reflux oesophagitis at 4 and 8 weeks. Other PPIs show similar healing rates as omeprazole. Level of evidence: "A"

A systematic review 1 including twelve RCTs on the effectiveness of esomeprazole in the healing of reflux oesophagitis was abstracted in DARE (number of participants not reported). Further six RCTs were excluded from the primary analysis due to a low quality score.

Endoscopic healing rates of esomeprazole (40 mg) compared with omeprazole (20 mg): the RR was 1.14 (95% CI: 1.10, 1.18) at 4 weeks (n=3) and 1.08 (95%CI: 1.05, 1.10) at 8 weeks (n=3). Pooling the data for lansoprazole, pantoprazole and rabeprazole compared with omeprazole showed no statistically-significant difference in treatment at 4 weeks (RR 1.01, 95% CI: 0.97, 1.06) and at 8 weeks (RR 1.07, 95% CI: 1.01, 1.13). The chi-squared test indicated significant heterogeneity for the comparison of esomeprazole with omeprazole.

Another meta-analysis 2 found esomeprazole 40 mg to be superior to omeprazole 20 mg in gastro-oesophageal reflux disease with RR 1.18 (95% CI 1.14-1.23). The general conclusion of this meta-analysis was that the difference between the different PPIs may be dose dependent and not proton pump inhibitor specific. Therefore, when prescribing proton pump inhibitors, arguments other than clinical efficacy, such as those related to pharmaco-economics, may be considered.

    References

    • Edwards SJ, Lind T, Lundell L. Systematic review of proton pump inhibitors for the acute treatment of reflux oesophagitis. Aliment Pharmacol Ther 2001 Nov;15(11):1729-36. [PubMed]
    • Klok RM, Postma MJ, van Hout BA, Brouwers JR. Meta-analysis: comparing the efficacy of proton pump inhibitors in short-term use. Aliment Pharmacol Ther 2003 May 15;17(10):1237-45. [PubMed]

Primary/Secondary Keywords