Management of reflux esophagitis: does the choice of proton pump inhibitor matter?

Summary 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. Aim To compare esomeprazolewith lansoprazoleor pantoprazolefor RE management using a management model. Methods Data from six studies comparing esomeprazolewith lansoprazoleor pantoprazolefor healing (4–8 weeks) or maintenance of healing (6 months) of RE were incorporated into hypotheticalmanagement 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 neededto treat(NNT) to achieve one more patient in remission with esomeprazolevs. other PPIs was estimated. The hypotheticalmodel was validated using results from the EXPO study, which compared esomeprazolewith pantoprazolefor RE healing and maintenance. Results Overall, esomeprazole40 mg produced higher rates of healing ( life-tableestimates) than lansoprazole30 mg (82.4–92.6% vs. 77.5–88.8%; p < 0.01) or pantoprazole40 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-tableestimates) or pantoprazole(70.9% vs. 59.6%; p < 0.0001; observed rates). In the hypotheticalmanagement model, the NNT for esomeprazolewas 9 vs. lansoprazoleand 8 vs. pantoprazole. The actual NNT for esomeprazolevs. pantoprazolein the EXPO study was 9 (95% confidence interval: 6; 16). Conclusions In this management model, esomeprazolewas more effective than either lansoprazoleor pantoprazolefor maintaining remission after sequential healing and 6 months’ maintenance therapyfor RE.