A new study, involving more than 1,000 patients with healed erosive esophagitis, has shown that Esomeprazole ( Nexium ) is more effective than Lansoprazole ( Prevacid ) in preventing a recurrence and is equally effective in reducing its associated symptoms.

Esomeprazole and Lansoprazole are proton pump inhibitors ( PPIs ).

An estimated one in three people with acid reflux disease develop erosive esophagitis, in which stomach acid begins to wear away, or erode, the inner lining of the esophagus.
Acid reflux disease is a condition in which the valve between the esophagus and stomach doesn't close properly, allowing acid to leak back into the esophagus. Symptoms of acid reflux disease and erosive esophagitis are similar and may include persistent heartburn, acid regurgitation, bitter taste in the mouth, and difficulty swallowing.

The trial was a randomized, double-blind, parallel-group study to compare the endoscopic and symptomatic remission rates of Esomeprazole with those of Lansoprazole in patients with healed grade A-D erosive esophagitis.

Patients had been treated and healed ( no endoscopic evidence of erosive esophagitis ) with Esomeprazole 40 mg or Lansoprazole 30 mg once daily ( patients with Los Angeles grades C and D erosive esophagitis at baseline ) or Esomeprazole 40 mg ( patients with Los Angeles grades A and B erosive esophagitis at baseline ) and had no heartburn or acid regurgitation symptoms during the previous week.

A total of 1,026 patients were randomized to once-daily therapy with either Esomeprazole 20 mg ( n=512 ) or Lansoprazole 15 mg ( n=514 ) for up to 6 months.

An esophagogastroduodenoscopy ( EGD ) was performed at 3 and 6 months to determine the relative remission rates of both treatment groups.

The estimated endoscopic/symptomatic remission rate during a period of 6 months was significantly higher ( P = .0007 ) for patients who received Esomeprazole 20 mg once daily ( 84.8% ) compared with those who received Lansoprazole 15 mg ( 75.9% ).

Most patients had no heartburn or acid regurgitation symptoms at 6 months, and there were no significant differences between treatments.

Both treatments were well-tolerated.

“ The challenge in treating erosive esophagitis is that many patients who are successfully treated with an acid-suppressing medication, such as a PPI, will commonly relapse within a year if that medication is discontinued. Reflux symptoms are chronic in many patients, particularly those with erosive esophagitis," said Kenneth DeVault, at Mayo Clinic College of Medicine, Jacksonville, Florida, and the lead study investigator.

“ The study showed that Esomeprazole was more effective than Lansoprazole in meeting one of the important yardsticks for clinical success - maintaining healing of erosive esophagitis," added DeVault.

Source: Clinical Gastroenterology and Hepatology, 2006


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