title: Management of reflux esophagitis: does the choice of proton pump inhibitor matter?
abstract: BACKGROUND
  Proton pump inhibitors (PPIs) are the treatment of choice for reflux esophagitis (RE). The effectiveness of PPIs throughout RE management, from healing to maintenance, has not been fully studied.
  
  
  OBJECTIVE
  To compare esomeprazole with lansoprazole or pantoprazole for RE management using a management model.
  
  
  METHODS
  Data from six studies comparing esomeprazole with lansoprazole or pantoprazole for healing (4-8 weeks) or maintenance of healing (6 months) of RE were incorporated into hypothetical management models to determine the proportion of patients in endoscopic remission after sequential healing and maintenance therapy, assuming that patients received the same PPI throughout. The number needed to treat (NNT) to achieve one more patient in remission with esomeprazole vs. other PPIs was estimated. The hypothetical model was validated using results from the EXPO study, which compared esomeprazole with pantoprazole for RE healing and maintenance.
  
  
  RESULTS
  Overall, esomeprazole 40 mg produced higher rates of healing (life-table estimates) than lansoprazole 30 mg (82.4-92.6% vs. 77.5-88.8%; p < 0.01) or pantoprazole 40 mg (95.5% vs. 92.0%; p < 0.001) and higher rates of endoscopic and symptomatic remission at 6 months than lansoprazole (83.0-84.8% vs. 74.0-75.9%; p < 0.001; life-table estimates) or pantoprazole (70.9% vs. 59.6%; p < 0.0001; observed rates). In the hypothetical management model, the NNT for esomeprazole was 9 vs. lansoprazole and 8 vs. pantoprazole. The actual NNT for esomeprazole vs. pantoprazole in the EXPO study was 9 (95% confidence interval: 6; 16).
  
  
  CONCLUSIONS
  In this management model, esomeprazole was more effective than either lansoprazole or pantoprazole for maintaining remission after sequential healing and 6 months' maintenance therapy for RE.
authors.affiliation: Medical Department, Diakonie Klinikum Jung-Stilling, Siegen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Labenz
authors.affiliation: Division of Gastroenterology, McMaster University, Hamilton, ON, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Armstrong
authors.affiliation: Medical Department, Ev. Krankenhaus, Herne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Leodolter
authors.affiliation: AstraZeneca Pharmaceuticals LP, Biometrics and Information Sciences, Wilmington, DE, USA.
authors.forename: I
authors.initials: I
authors.lastname: Baldycheva
mesh_terms: D000284:Administration, Oral; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D064098:Esomeprazole / Q000008:administration & dosage*; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D064747:Lansoprazole / Q000008:administration & dosage*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D064098:Esomeprazole