Clinical trial: intragastric acid control in patients who have Barrett’s oesophagus—comparison of once- and twice-daily regimens of esomeprazole and lansoprazole


Dr S. J. Spechler, Division of Gastroenterology, Dallas VA Medical Center, 4500 S. Lancaster Rd. [111B], Dallas, TX 75216, USA.


Background  Gastric acid control is important for treatment of gastro-oesophageal reflux disease associated with Barrett’s oesophagus. Substantial indirect evidence suggests that gastric acid control may have a chemopreventive role in Barrett’s oesophagus.

Aim  To compare the pharmacodynamic efficacy of esomeprazole and lansoprazole at two dosages for intragastric pH control with Barrett’s oesophagus.

Methods  Patients with Barrett’s oesophagus received open-label consecutive treatment (a 15-day period of once-daily dosing followed by a 10-day period of twice-daily dosing) with esomeprazole (40-mg capsules) and lansoprazole (30-mg capsules) in random order with no washouts. Twenty-four-hour intragastric pH was recorded on the last day of each dosing period. The primary end point was the percentage of time with intragastric pH > 4.0.

Results  In the per-protocol once- (= 46) and twice-daily (= 41) analyses, the percentage of time with intragastric pH > 4.0 was significantly (< 0.0001) longer after once- (67.1%) or twice-daily (81.2%) esomeprazole than after once- (50.8%) or twice-daily (64.3%) lansoprazole. The proportion of patients with intragastric pH > 4.0 for >12 h was significantly higher for esomeprazole than lansoprazole with once- (= 0.004) and twice-daily (= 0.016) dosing.

Conclusion  Esomeprazole 40 mg is significantly more effective than lansoprazole 30 mg in controlling intragastric pH with Barrett’s oesophagus.