Daytime Intragastric pH With Esomeprazole 20 mg: New Comparative Analyses With Other Proton Pump Inhibitors Omeprazole 20 mg, Lansoprazole 15 mg, and Pantoprazole 20 mg

Purpose: In untreated patients with gastroesophageal reflux disease (GERD), the major burden of high rates of acid reflux and frequent heartburn symptoms occurs during waking hours. Using data from previously published studies that evaluated the 24-hour control of intragastric pH by esomeprazole and other proton-pump inhibitors (PPIs)1-4, we conducted new analyses focusing on intragastric pH in the 14-hour awake period for esomeprazole 20 mg and over-the-counter (OTC) doses of other PPIs. Methods: In one double-blind1 and three open-label2-4 randomized, crossover studies, intragastric pH was monitored for 24 hours on day 5 of treatment. In this post-hoc analysis, acid control with OTC PPIs was reassessed for the 14-hour daytime period. Mean percentage of time with pH >4 was estimated for each study using a linear mixed-effect model that included treatment, treatment period, and treatment sequence as fixed effects and subject nested with treatment sequence as a random effect. Using the same model, geometric mean ratios were estimated based on log-transformed individual values. Results: The results are presented in Table 1.Table 1: Intragastric Acid Control During the 14-hour Daytime Period With Esomeprazole 20 mg vs Other PPIsConclusion: During the period of daytime food-stimulated acid secretion and postprandial reflux, esomeprazole 20 mg provided acid control for a significantly greater average portion of the time vs. other PPIs at OTC doses. As the majority of reflux occurs during the day, we postulate that better control of daytime intragastric pH should translate to improved treatment of acid-related inflammation and sensitization of the esophagus and thereby better-directed symptomatic control of frequent heartburn.