Meta-analysis of the Efficacy and Safety of Esomeprazole in the Tratment of Gastroesophageal Reflux DiseaseNalinee Poolsup, Adawan Paiprasert
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This research was aimed at evaluating the efficacy and safety of esomeprazole compared with omeprazole and lansoprazole in the treatment of gastroesophageal reflux disease. Clinical trials of esomeprazole were identifed through electronic searches (Medline, EMBASE, the Cochrane Library, ERIC, Scisearch, CINAHL, BIOSIS) and historical searches. For a trial to be included, it had to be 1) randomized, double-blind controlled trial; 2) published in English; and 3) at least 4 weeks of study duration. The studies were included in statistical pooling if they provided the efficacy data in terms of healing rate or heartburn resolution rate. The efficacy and safety were estimated using risk ratio, risk difference, and number needed to treat together with 95% confidence intervals. Four trials involving a total of 9910 patients were included. Esomeprazole 40 mg was more effective than omeprazole 20 mg in the healing of erosive esophagitis (RR 1.17, 95% CI 1.13-1.22, p0.0001 at week 4 and 1.10, 95% IC 1.07-1.13, p0.0001 at week 8). Complete heartburn resolution was also better with esomeprazole 40 mg than with omeprazole 20 mg (RR 1.16, 95% CI 1.10-1.22, p0.0001). There were no significant differences between esomeprazole 20 mg and omeprazole 20 mg. Esomeprazole 40 mg was superior to lansoprazole 30 mg in all outcome measures. Healing risk ratio were 1.05 (95% CI 1.02-1.09, p = 0.001) and 1.04 (95% CI 1.02-1.06, p = 0.0008) at week 4 and week 8, respectively. Healing risk difference yielded the mean number needed to treat of 25 (95% CI 17-50) and 32 (95% CI 20-77), respectively. Complete heartburn resolution risk ratio and risk difference were 1.05 (95% CI 1.0033-1.10, p = 0.035) and 0.03 (95% CI 0.002-0.055, p = 0.035), respectively. Esomeprazole caused no more treatment-related adverse events than omeprazole or lansoprazole. The current evidence suggests that esomeprazole 40 mg may be more effective and cause no more adverse events than omeprazole 20 mg and lansoprazole 30 mg in the treatment of GERD. © All rights reserved.
Keyword:
Meta-analysis , Esomeprazole,Gastroesophageal Reflux Disease , omeprazole ,lansoprazole , heartburn
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