Systematic review: proton pump inhibitors (PPIs) for the healing of reflux oesophagitis – a comparison of esomeprazole with other PPIs

Authors


Mr S. J. Edwards, Outcomes Research, AstraZeneca UK Ltd, Horizon Place, 600 Capability Green, Luton, Bedfordshire LU1 3LU, UK.
E-mail: steven.j.edwards@astrazeneca.com

Abstract

Summary

Background

No randomized controlled trial has compared all the licensed standard dose proton pump inhibitors in the healing of reflux oesophagitis.

Aim

To compare the effectiveness of esomeprazole with licensed standard dose proton pump inhibitors for healing of reflux oesophagitis (i.e. lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg and rabeprazole 20 mg).

Methods

Systematic review of CENTRAL, BIOSIS, EMBASE and MEDLINE for randomized controlled trials in patients with reflux oesophagitis. Searching was completed in February 2005. Data on endoscopic healing rates at 4 and 8 weeks were extracted and re-analysed if not analysed by intention-to-treat. Meta-analysis was conducted using a fixed effects model.

Results

Of 133 papers identified in the literature search, six were of sufficient quality to be included in the analysis. No studies were identified comparing rabeprazole with esomeprazole. A meta-analysis of healing rates of esomeprazole 40 mg compared with standard dose proton pump inhibitors gave the following results: at 4 weeks [relative risk (RR) 0.92; 95% CI: 0.90, 0.94; P < 0.00001], and 8 weeks (RR 0.95; 95% CI: 0.94, 0.97; P < 0.00001). Publication bias did not have a significant impact on the results. The results were robust to changes in the inclusion/exclusion criteria and using a random effects model.

Conclusion

Esomeprazole consistently demonstrates higher healing rates when compared with standard dose proton pump inhibitors.

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