Meta-analysis of the effectiveness of esomeprazole in gastroesophageal reflux disease and Helicobacter pylori infection

What is known and objectiveProton pump inhibitors (PPIs) are one of the most widely used classes of drugs. However, the quantum clinical benefit of newer and more expensive PPIs over the older generation PPIs remains uncertain. This meta-analysis sought to assess the clinical and safety profiles of esomeprazole versus omeprazole at pharmacologically equivalent doses in healing gastroesophageal reflux disease (GERD), peptic ulcer disease and eradicating Helicobacter pylori (H.pylori) infection. MethodsPubMed and the Cochrane Library were searched for randomized controlled trials comparing esomeprazole with omeprazole at all doses up to February 2015. Trials were assessed by two reviewers for eligibility according to predefined study inclusion criteria. Meta-analysis was conducted using a random effects model, and heterogeneity in the estimated effects was investigated using meta-regression. Sensitivity analysis was performed to test the robustness of the findings. Results and DiscussionFifteen trials were included and none of which compared esomeprazole with omeprazole in peptic ulcer disease. The included studies had not evaluated esomeprazole 20mg versus omeprazole 40mg. In GERD, esomeprazole 40mg (relative risk (RR)=107; 95% confidence interval (CI) 102 to 112) and 20mg (RR=104; 95% CI 101 to 108) significantly improved esophagitis healing when compared with omeprazole 20mg at week 8. The corresponding numbers needed to treat were 17 and 30, respectively. No significant difference was observed between esomeprazole 20mg and omeprazole 20mg at week 4. In H.pylori eradication, there was no difference in the treatment effects between esomeprazole 20mg and omeprazole 20mg (RR=101;95% CI 096 to 105). Their safety profiles were comparable. What is new and conclusionEsomeprazole demonstrated better esophagitis healing rate in patients with GERD than omeprazole at week 8. However, this clinical advantage diminished when both drugs were given at the same doses at week 4. Superiority of esomeprazole was not observed in the H.pylori eradication rates.