A comparison of omeprazole, lansoprazole and pantoprazole in the maintenance treatment of severe reflux oesophagitis

Abstract

INTRODUCTIONPeptic oesophageal stricture is a consequence of chronic erosive oesophagitis. 1, 2 The non-surgical approach is directed at dilating the luminal diameter by serial bougienage 1 followed by therapy with a proton pump inhibitor. 3±7 A prospective and controlled study was performed in order to compare the effects of omeprazole, lansoprazole or pantoprazole in the maintenance treatment of complicated gastro-oesophageal re¯ux disease. METHODSWe recruited outpatients with endoscopically con®rmed severe oesophagitis and peptic stricture. Inclusion criteria were: grade 4 oesophagitis according to the Savary±Miller classi®cation (oesophagitis with multiple circumferential erosions and stricture 8 ) and one or more of four symptoms (heartburn, pain, regurgitation and solid food dysphagia). Exclusion criteria included age under 18 years; pregnancy; malignant oesophageal stenosis; oesophagogastric surgery; serious renal, cardiac, hepatic or pulmonary disease; and expected poor compliance with treatment. SUMMARYBackground: Proton pump inhibitors are effective for the healing of oesophagitis. Standard doses of omeprazole, lansoprazole or pantoprazole are suf®cient for healing in mild to moderate cases of oesophagitis. Aim: To compare the ef®cacy of double the standard doses of omeprazole, lansoprazole or pantoprazole for maintenance treatment of severe oesophagitis complicated by a stricture. Methods: Thirty-six patients with re¯ux oesophagitis and stricture con®rmed by endoscopy were included in a prospective study comparing three maintenance therapies. In all cases weekly dilatation of the stenosis was performed and patients were treated with omeprazole 20 mg b.d. until healing of oesophagitis and dysphagia relief were achieved. Thirty participants responded to therapy and were then randomly assigned

Relative Efficacies of Gastric Proton Pump Inhibitors: Their Clinical and Pharmacological Basis

“…This procedure clearly causes a bias in favor of omeprazole and may therefore explain the outcome [155,156]. The difference in remission rates in favor of omeprazole compared to both lansoprazole and pantoprazole in the GERD study [153] cannot be explained by the pharmacological drug properties [157] (see last section) and is in sharp contrast to many other studies (table 5). This strongly suggests that the data shown in table 7 should be regarded as incidental.…”

“…To confuse the situation even more, 20 mg omeprazole twice daily appeared to be highly superior to both 30 mg lansoprazole and 40 mg pantoprazole twice daily in the GERD study [153], although both lansoprazole versus omeprazole and pantoprazole versus omeprazole were equieffective at these doses, once daily, in a number of other studies (table 3). As shown in table 1, even identical doses of omeprazole and pantoprazole were equieffective in various study parameters.…”

“…Whereas the GERD study [153] does not show any difference between (twice daily) 30 mg lansoprazole and 40 mg pantoprazole with respect to endoscopic remission and recurrence of reflux symptoms, the pH-metry study [152] seems to suggest that 30 mg lansoprazole is superior to 40 mg pantoprazole. To confuse the situation even more, 20 mg omeprazole twice daily appeared to be highly superior to both 30 mg lansoprazole and 40 mg pantoprazole twice daily in the GERD study [153], although both lansoprazole versus omeprazole and pantoprazole versus omeprazole were equieffective at these doses, once daily, in a number of other studies (table 3).…”

“…Occasional results of this type, being at variance with the great majority of other data, must have been obtained double-blind and have to be consistent with the pharmacological drug properties in order to be considered meaningful. These two prerequisites are met neither by an open 24-hour pH-metry study [152] nor by a GERD study [153].…”

“…The GERD study mentioned above [153] was done open as to the assessment of symptom relief and single-blind as to endoscopic evaluation, and it included only 10 patients/ group. Of particular importance is that the patients had been selected on the basis of their sensitivity to omeprazole and only afterwards randomized to either lansoprazole, omeprazole or pantoprazole.…”