Esomeprazole Most Effective for Gastric Acid Control

Laurie Barclay, MD

December 18, 2003

Dec. 17, 2003 — Esomeprazole is the most effective proton pump inhibitor (PPI) for gastric acid control, according to the results of a five-way crossover study published in the December issue of the American Journal of Gastroenterology.

"The amount of time that intragastric pH is greater than 4.0 is a parameter that is frequently used to evaluate the pharmacodynamics and clinical effects of treatment with PPIs in patients with acid-related diseases," write Philip Miner, Jr., MD, from the University of Oklahoma in Oklahoma City, and colleagues. "This study is the first published comparative pharmacodynamic trial to use a five-way crossover design and provide the same controlled conditions across all treatment groups."

In this open-label study, 34 H. pylori–negative patients, aged 18 to 60 years with symptoms of gastroesophageal reflux (GER) disease, were randomized to one of five treatment sequences. Study drug was taken on five consecutive mornings, given once daily 30 minutes before subjects ate a standardized breakfast. Each treatment phase was separated by a washout period of at least 10 days.

On the fifth day of treatment, the mean number of hours in which intragastric pH was greater than 4.0 was 14.0 hours with esomeprazole 40 mg, 12.1 hours with rabeprazole 20 mg, 11.8 hours with omeprazole 20 mg, 11.5 hours with lansoprazole 30 mg, and 10.1 hours with pantoprazole 40 mg ( P < .001 for esomeprazole vs. all others). Compared with the other drugs, esomeprazole was associated with a higher percentage of patients with intragastric pH greater than 4.0 for more than 12 hours ( P < .05).

The number of adverse events was not significantly different during any of the five treatments. Study limitations include the open-label design and failure to test any clinical endpoints.

"This randomized, five-way crossover trial demonstrated that standard-dose esomeprazole (40 mg once daily) suppresses intragastric acid production for a greater amount of a 24-hour period in patients with symptoms of GER than do standard doses of other PPIs," the authors write.

AstraZeneca employs one of the study authors.

Am J Gastroenterol. 2003;98:000-000

Reviewed by Gary D. Vogin, MD

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