PubMed · 11454811
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M J Langman. 2001. Which PPI?. https://doi.org/10.1136/gut.49.2.309
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BACKGROUND: Gastric ulcers are a frequent problem in the United States. Proton pump inhibitors have been shown to increase healing rates and improve clinical symptoms. The objective of this study is to compare gastric ulcer healing rates for patients treated with a proton pump inhibitor (PPI) (omeprazole, rabeprazole, pantoprazole, or lansoprazole), an histamine 2- receptor antagonist (ranitidine) or placebo. METHODS: A literature search was conducted to identify randomized, controlled clinical trials that included a PPI in at least one treatment arm and assessed the gastric ulcer healing rates endoscopically. The healing rates were estimated for each treatment at specific time points, and Rate Ratios (RR) and 95% confidence intervals (CI) were estimated for each trial. RESULTS: Sixteen trials met the inclusion criteria: four compared a PPI versus placebo, nine compared a PPI versus ranitidine (no trials of rabeprazole versus ranitidine met the inclusion criteria), and three compared a newer PPI (lansoprazole, pantoprazole or rabeprazole) versus omeprazole. In relation to ranitidine, the pooled RR of PPIs (lansoprazole, omeprazole and pantoprazole) was 1.33 (95% CI 1.24 to 1.42) at four weeks. In each trial, greater improvement in the studied clinical symptoms was found with the newer PPIs (rabeprazole, pantoprazole and lansoprazole) when compared to omeprazole. CONCLUSION: In this study treatment with PPIs resulted in higher healing rates than ranitidine or placebo. This evidence suggests that the first choice for gastric ulcer treatment for the greater relief of symptoms is one of the newer PPIs.
Gastroesophageal reflux disease (GERD) is one of the most common medical problems. The large majority of patients so affected have no endoscopically evident disease, or only mild erosive reflux esophagitis. Since both forms of GERD are probably non-progressive, on-demand therapy aimed at adequately controlling symptoms is safe treatment. Proton pump inhibitors (PPI) are the drugs of choice for acute and long-term treatment. In 1999, the first study reporting on on-demand therapy with omeprazole was published. A clear superiority over placebo was found, as was also dependence of the effect on the dose. In the recent past, publications have reported on on-demand therapy with the s-isomer of omeprazole--esomeprazole. With success rates of around 90%, on-demand therapy has proven to be highly effective. On average, the patients take one 20 mg tablet of esomeprazole on every third to fourth day.
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