title: A multicentre randomised trial to compare the efficacy of omeprazole versus rabeprazole in early symptom relief in patients with reflux esophagitis.
abstract: BACKGROUND
  Proton 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.
  
  
  METHODS
  Patients 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.
  
  
  RESULTS
  Of 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.
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan, nagahara@juntendo.ac.jp.
authors.forename: Akihito
authors.initials: A
authors.lastname: Nagahara
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.forename: Nozomu
authors.initials: N
authors.lastname: Sugai
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Kouichi
authors.initials: K
authors.lastname: Sakurai
authors.forename: Masaki
authors.initials: M
authors.lastname: Miyamoto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Inoue
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Mabe
authors.forename: Ichiro
authors.initials: I
authors.lastname: Konuma
authors.forename: Tomoari
authors.initials: T
authors.lastname: Kamada
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
mesh_terms: D000328:Adult; D000368:Aged; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics; D004942:Esophagitis, Peptic / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D010641:Phenotype; D011110:Polymorphism, Genetic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D064750:Rabeprazole / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors; D064750:Rabeprazole; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D009853:Omeprazole