Systematic review of proton pump inhibitors for the acute treatment of reflux oesophagitis.
BACKGROUND
Esomeprazole is a new proton pump inhibitor, which has been compared to omeprazole for the treatment of reflux oesophagitis in clinical trials.


OBJECTIVE
To compare the effectiveness of esomeprazole with the recommended dose of proton pump inhibitors in the healing of reflux oesophagitis, using omeprazole as a common comparator.


METHODS
Systematic review of randomized controlled trials. Extraction and re-analysis of data to provide 'intention-to-treat' results. Meta-analysis using a Fixed Effects model.


RESULTS
A meta-analysis of healing rates of esomeprazole 40 mg compared to omeprazole 20 mg gave the following results: at 4 weeks (relative risk 1.14; 95% CI: 1.10, 1.18) and 8 weeks (RR 1.08; 95%CI: 1.05, 1.10). Other proton pump inhibitors compared to omeprazole 20 mg are as follows: lansoprazole 30 mg at 4 weeks (RR 1.02; 95%CI: 0.97, 1.08) and 8 weeks (RR 1.01; 95%CI: 0.97, 1.06); pantoprazole 40 mg at 4 weeks (RR 0.99; 95%CI: 0.91, 1.07) and 8 weeks (RR 0.98; 95%CI: 0.93, 1.04); rabeprazole 20 mg at 4 weeks (RR 1.00; 95%CI: 0.87, 1.14) and 8 weeks (RR 0.98; 95%CI: 0.91, 1.05).


CONCLUSIONS
Esomeprazole has demonstrated higher healing rates than omeprazole at 4 and 8 weeks. Other proton pump inhibitors (lansoprazole, pantoprazole and rabeprazole) have not shown higher healing rates when compared with omeprazole.
Edwards
S J
SJ
Outcomes Research, AstraZeneca, Kings Langley, UK. steven.j.edwards@astrazeneca.com
Lind
T
T
Lundell
L
L
D000284:Administration, Oral; D004305:Dose-Response Relationship, Drug; D004791:Enzyme Inhibitors / Q000494:pharmacology*; D064098:Esomeprazole; D004942:Esophagitis, Peptic / Q000188:drug therapy*; D006801:Humans; D009853:Omeprazole / Q000031:analogs & derivatives / Q000494:pharmacology*; D054328:Proton Pump Inhibitors; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D009853:Omeprazole; D064098:Esomeprazole