Proton pump inhibitors (PPIs) are the best treatment of GERD with or without endoscopic esophagitis.
However, optimal dosing of PPIs has been a matter of debate for several years.
A study published in Gastroenterology by Scholten and colleagues addressed this topic. It showed that 40 mg pantoprazole provided superior symptom relief to 20 mg omeprazole in 360 patients with severe heartburn.
In particular, the patients taking pantoprazole reported faster relief of their symptoms.
Patients taking omeprazole had to wait 4 days to experience the relief felt at only 2 days by patients receiving pantoprazole.
Other studies have suggested that treatment with 40 mg esomeprazole, the S-isomer of omeprazole, is superior to 20 mg omeprazole. Therefore, the latest studies compared pantoprazole with esomeprazole.
A pH-metry study by Simon et al., published in the American Journal of Gastroenterology, showed that 40 mg pantoprazole reduced the duration of reflux to the same extent as 40 mg esomeprazole.
This was a double-blind cross-over study of 48 patients with GERD symptoms and reflux occurring more than 6% of the time.
More recently, two studies have confirmed the milligram-for-milligram equivalence of pantoprazole and esomeprazole, in terms of both endoscopically confirmed healing and clinical symptoms.
Professor V. Stanghellini presented these on 2 November 2001, at the International Forum on Endoscopy, in his state-of-the-art lecture.
| Comparably high GERD healing rates were achieved with pantoprazole and esomeprazole.
The first study was a double-blind trial, comparing the effects of equal doses of pantoprazole and esomeprazole on endoscopically confirmed healing in 227 GERD patients.
Patients were randomized to receive 40 mg of either pantoprazole or esomeprazole once daily.
Comparably high healing rates were achieved with pantoprazole (95%) and esomeprazole (90%), thereby demonstrating statistically significant equivalence of the two drugs.
Both drugs were well tolerated, and no drug-related adverse events were reported in either group.
The second study confirmed the efficacy of pantoprazole in treating the symptoms of GERD.
Over 200 patients took 40 mg of either pantoprazole or esomeprazole once daily, for 4 weeks.
They recorded the occurrence and severity of heartburn, belching, indigestion, pressure in the chest, and feelings of fullness and flatulence, using daily diaries.
Taking either pantoprazole or esomeprazole had a dramatic effect on their symptoms, confirming that they provide equivalent symptom relief.
There were no statistically significant differences in symptom load reduction, and both drugs were well tolerated.
Taken together, these studies clearly demonstrate that pantoprazole is equivalent to esomeprazole, on a mg-for-mg basis, comments Reiner Link, of Byk Gulden.
Treatment with pantoprazole leads to similar rates of healing and symptom relief. However, it has benefits over esomeprazole. In particular, it can be prescribed without concern over drug-drug interactions.
These have been a problem with other PPIs, which may react with common medications such as diazepam, phenytoin, and anticoagulants.
Studies with pantoprazole, however, have confirmed that it does not interact with these or any of the other drugs tested and so can be prescribed safely alongside co-medication.