title: Meta-analysis of the effectiveness of esomeprazole in gastroesophageal reflux disease and Helicobacter pylori infection.
abstract: OBJECTIVE
  Proton pump inhibitors (PPIs) are one of the most widely used classes of drugs. However, the quantum clinical benefit of newer and more expensive PPIs over the older generation PPIs remains uncertain. This meta-analysis sought to assess the clinical and safety profiles of esomeprazole versus omeprazole at pharmacologically equivalent doses in healing gastroesophageal reflux disease (GERD), peptic ulcer disease and eradicating Helicobacter pylori (H. pylori) infection.
  
  
  METHODS
  PubMed and the Cochrane Library were searched for randomized controlled trials comparing esomeprazole with omeprazole at all doses up to February 2015. Trials were assessed by two reviewers for eligibility according to predefined study inclusion criteria. Meta-analysis was conducted using a random effects model, and heterogeneity in the estimated effects was investigated using meta-regression. Sensitivity analysis was performed to test the robustness of the findings.
  
  
  CONCLUSIONS
  Fifteen trials were included and none of which compared esomeprazole with omeprazole in peptic ulcer disease. The included studies had not evaluated esomeprazole 20 mg versus omeprazole 40 mg. In GERD, esomeprazole 40 mg (relative risk (RR) = 1·07; 95% confidence interval (CI) 1·02 to 1·12) and 20 mg (RR=1·04; 95% CI 1·01 to 1·08) significantly improved esophagitis healing when compared with omeprazole 20 mg at week 8. The corresponding numbers needed to treat were 17 and 30, respectively. No significant difference was observed between esomeprazole 20 mg and omeprazole 20 mg at week 4. In H. pylori eradication, there was no difference in the treatment effects between esomeprazole 20 mg and omeprazole 20 mg (RR = 1·01;95% CI 0·96 to 1·05). Their safety profiles were comparable.
  
  
  CONCLUSIONS
  Esomeprazole demonstrated better esophagitis healing rate in patients with GERD than omeprazole at week 8. However, this clinical advantage diminished when both drugs were given at the same doses at week 4. Superiority of esomeprazole was not observed in the H. pylori eradication rates.
authors.affiliation: Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: M
authors.initials: M
authors.lastname: Teng
authors.affiliation: Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: A L
authors.initials: AL
authors.lastname: Khoo
authors.affiliation: Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Zhao
authors.affiliation: Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: L
authors.initials: L
authors.lastname: Lin
authors.affiliation: Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore.
authors.forename: B P
authors.initials: BP
authors.lastname: Lim
authors.affiliation: Department of Pharmacy, National University Hospital, Singapore.
authors.forename: T S
authors.initials: TS
authors.lastname: Wu
authors.affiliation: Department of Medicine, National University Hospital, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Dan
mesh_terms: D064098:Esomeprazole / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000382:microbiology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D009853:Omeprazole / Q000009:adverse effects / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D054328:Proton Pump Inhibitors; D009853:Omeprazole; D064098:Esomeprazole
keywords: Helicobacter pylori; esomeprazole; gastroesophageal reflux; meta-analysis; omeprazole; systematic review