Comparable Efficacy of Pantoprazole and Omeprazole in Patients with Moderate to Severe Reflux Esophagitis

Körner, T. W.; Schütze, K; Leendert, R.J.M. van; Fumagalli, I.; Neves, Beatriz; Bohuschke, Martina; Gatz, Gudrun

doi:10.1159/000070201

Cited by 32 publications

(12 citation statements)

References 12 publications

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“…Several recent publications have indicated that the optimal dose for healing moderate/severe erosive esophagitis is 40 mg of a PPI daily [21, 22, 23, 24]. The widespread use of PPIs testifies to the symptomatic benefits that they offer also in nonerosive disease.…”

Section: Medical Therapymentioning

confidence: 99%

GERD 2003 – A Consensus on the Way Ahead

et al. 2003

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Gastroesophageal reflux disease (GERD) has in recent times become an important public health issue owing to the considerable health care resources utilized in its management, its deleterious effect on quality of life and the increasing prevalence of a relatively rare complication of reflux disease – esophageal adenocarcinoma. We review here the major current challenges in the field of reflux disease and its complications, and provide some approaches that may be useful in management. The issues to be faced include the very limited comprehension of the reasons behind the increasing prevalence of the disease, difficulties in correlating symptoms with objective data of pathological gastroesophageal reflux and the relatively unsophisticated tools we are employing to investigate the underlying pathophysiology. It is certain that the lack of well-defined and characterized methodologies to compare the effects of therapy require the development of more effective questionnaire-type analytic tools. In regard to treatment, there is little doubt that the widely prescribed proton pump inhibitors have dose-equivalent efficacy and are the most highly effective agents capable of suppressing acid, controlling many of the symptoms of GERD and healing erosions. Nevertheless, many patients continue to experience symptoms on withdrawal or at night. Pharmacological agents that can effectively increase lower esophageal sphincter pressure or promote motility are as yet unavailable. Although the introduction of laparoscopic techniques has resulted in a modest revival in surgical intervention using a variety of ‘wrap-type’ operations, the indications are few and the procedure is associated with a significant morbidity and even mortality especially if the expertise of the surgeon is an issue. Endoscopic techniques of regulating reflux are at this time experimental and not applicable to the general population. Intestinal metaplasia in the lower esophagus is probably very common. Whether and how to, first, screen for, and then, perform surveillance in Barrett’s esophagus remains highly problematic and contentious.

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Section: Medical Therapymentioning

confidence: 99%

GERD 2003 – A Consensus on the Way Ahead

et al. 2003

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“…For the remaining majority of individuals who present to the primary care office with symptomatic GERD, it is safe and appropriate care to begin initial empiric PPI treatment without performing endoscopy [16]. Indeed, a recent meta-analysis comparing short-term use of PPIs has shown that, in GERD, a 40-mg daily dose of any PPI is more effective than a 20-mg dose in endoscopic healing [14], and several studies showed that PPIs are generally equivalent in terms of clinical efficacy [16, 20, 24, 25, 26]. …”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Pantoprazole versus Ranitidine in the Treatment of Patients with Symptomatic Gastroesophageal Reflux Disease

Zyl¹,

Rensburg

Vieweg

et al. 2004

Digestion

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Background/Aim: Gastroesophageal reflux disease (GERD) is a prevalent disease associated with a high symptom burden and a reduced quality of life. This multicenter, randomized, double-blind study compared relief from key GERD symptoms (heartburn, acid eructation, and pain on swallowing) and from other gastrointestinal symptoms (epigastric pain, vomiting, nausea, flatulence, retching, and retrosternal feeling of tightness) and safety profiles of the proton pump inhibitor pantoprazole and the H₂ antagonist ranitidine in patients suffering from symptomatic GERD. Methods: The patients [338 intention-to-treat (ITT) population; 284 per-protocol (PP) population] received 20 mg pantoprazole (once daily in the morning) plus ranitidine placebo (once daily in the evening; ITT n = 167, PP n = 136) or pantoprazole placebo (once daily in the morning) plus 300 mg ranitidine (once daily in the evening; ITT n = 171, PP n = 148) for 28 days. The primary efficacy criterion (ITT and PP populations) was relief from key GERD symptoms (heartburn, acid eructation, and pain on swallowing) after 28 days of treatment. Secondary criteria (PP) included relief from key GERD symptoms on day 14, relief from all gastrointestinal symptoms on days 14 and 28, and relief from key GERD symptoms on days 14 and 28. Safety evaluations included adverse events and laboratory assessments. Results: Significantly more pantoprazole-treated patients were free from key GERD symptoms at day 28 (68.3%, n = 114) as compared with ranitidine-treated patients (43.3%, n = 74; 95% confidence interval for odds ratio 1.84–4.51). Pantoprazole was also significantly more efficacious in controlling all gastrointestinal symptoms of GERD. By day 28, 51.5% (n = 70) of the pantoprazole-treated patients were completely symptom free versus 31.1% (n = 46) of the ranitidine-treated patients (95% confidence interval for odds ratio1.45–3.83). Both treatments were well tolerated. Conclusion: Pantoprazole is significantly superior to ranitidine in the treatment of key and associated gastrointestinal symptoms of GERD and is well tolerated.

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“…It is now widely believed that the appropriate daily doses for the treatment of moderate to severe forms of GERD are omeprazole (or its isomer esomeprazole) 40 mg, pantoprazole 40 mg, or lanscoprazole 30 mg. 25,26 Indeed, recent studies with GERD patients have demonstrated that, when used at the same dosage of 40 mg once daily (od), pantoprazole, omeprazole, and esomeprazole are 27 and to achieve high healing rates. 28,29 After 4-10 weeks of treatment, endoscopically confirmed healing was apparent in 95% of patients receiving pantoprazole (n ϭ 113) and in 90 of patients receiving esomeprazole (n ϭ 114); the difference between the two treatment groups was not statistically significant. 28 Furthermore, both drugs show similar efficacy with regard to the relief of symptoms.…”

Section: Treatment Strategiesmentioning

confidence: 97%

Heartburn in primary care: problems below the surface

2004

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Heartburn is a common physiological event often associated with an underlying occurrence of gastroesophageal reflux disease (GERD). Studies show that GERD is a highly prevalent and chronic condition that significantly impacts on the patient's quality of life (QoL) and, in the long term, increases the risk for developing esophageal adenocarcinoma, more commonly referred to as Barrett's esophagus. Data indicate that symptom severity is a poor predictor of either the presence of erosive mucosal lesions or the development of complications. Given that lifestyle modifications are often insufficient for long-term treatment of GERD, drugs that inhibit gastric acid production--such as the proton pump inhibitors (PPIs)--are now the most effective strategy. Although generally well tolerated, the potential of PPIs for interactions with other drugs needs to be considered. This review discusses the symptoms and risk factors associated with GERD, possible links to Helicobacter pylori infection, and effective treatment strategies within a primary care setting.

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Comparable Efficacy of Pantoprazole and Omeprazole in Patients with Moderate to Severe Reflux Esophagitis

Cited by 32 publications

References 12 publications

GERD 2003 – A Consensus on the Way Ahead

GERD 2003 – A Consensus on the Way Ahead

Efficacy and Safety of Pantoprazole versus Ranitidine in the Treatment of Patients with Symptomatic Gastroesophageal Reflux Disease

Heartburn in primary care: problems below the surface

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