In patients with Gastroesophageal Reflux

Disease is Esomeprazole

the most efficient proton pump inhibitor

to induce mucosal healing?Introdução à Medicina II Class 16

Summary• Rationale

• GERD• PPIs• Esomeprazole

• Study question, aim

• Methods• Results• Conclusions

Gastroesophageal Reflux Disease

(GERD)• The reflux of the stomach contents into the esophagus.

• Causes a range of troublesome symptoms:- heartburn;- acid regurgitation; - (…)

and complications: - hemorrhage, stricture; - Barrett’s esophagus; - adenocarcinoma of the distal esophagus.

Vakil et al. 2006Sonnenberg et al, 1999

Proton Pump Inhibitors (PPIs)

• Heal esophageal mucosal injury.

• Highly selective and effective in their action and have few short or long-term adverse effects.

• Eg.: Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole.

Pettit M (2005). Treatment of gastroesophageal reflux disease. Pharm World Sci. 27 (6):432-5.

Summary• Rationale

• GERD• PPIs• Esomeprazole

• Study question, aim

• Methods• Results• Conclusions

Esomeprazole• It’s administration

offers several pharmacokinetic advantages relatively to the first generation of PPIs.Coron E, Hatlebakk JG, Galmiche JP

(2007). Medical therapy of gastroesophageal reflux disease. Curr Opin Gastroenterol.23(4):434-9.

• Several studies have shown marginal differences in efficacy between various proton pump inhibitor regimens.

Glatzel D, Abdel-Qader M, Gatz G, Pfaffenberger B (2006). Pantoprazole 40 mg is as effective as Esomeprazole 40 mg to relieve symptoms of gastroesophageal reflux disease after 4 weeks of treatment and superior regarding the prevention of symptomatic relapse. Digestion. 74(3-4):145-54.

Summary• Rationale

• GERD• PPIs• Esomeprazole

• Study question, aim

• Methods• Results• Conclusions

Study question• Is Esomeprazole more effective in

healing mucosal injury, relatively to Omeprazole, Lansoprazole, Rabeprazole, Pantoprazole, in GERD patients?

Aim• To compare efficacy of Esomeprazole

relatively to others PPIs in:

inducing mucosal healing

in GERD patients.

Summary• Rationale• Study question,

aim• Methods• Results• Conclusions

• Study design Systematic review.

• Bibliographic databasesMedline (http://www.nlm.nih.gov/medlineplus/)Scopus (http://www.scopus.com/)ISI Web of Knowledge (http://isiwebofknowlegde.com/)

• Inclusion and exclusion criteria Inclusion criteria:

randomized clinical trials; focused on human adults (18 – 75 years old) with

GERD; treatment only with PPIs (Esomeprazole vs other); until December of 2007.

Exclusion criteria: studies in pregnant; studies in people with other illnesses beyond GERD.

Summary• Rationale• Study question,

aim• Methods

• Study design• Bibliographic

databases• Inclusion and

exclusion criteria

• Data to be extracted

• Results• Conclusions

Methods

Methods• Data to be extracted:

- number of individuals included in the study;- number of participants that abandoned the

study; - reasons of abandonment;- number of treated individuals;- number of treated men;- number of treated women;- age of the participants;- participants’ habits (smoking, drinking…);- classification of the reflux (participants’

symptoms);- duration of the study (time until healing endoscopy);

Summary• Rationale• Study question,

aim• Methods

• Study design• Bibliographic

databases• Inclusion and

exclusion criteria• Data to be

extracted• Results• Conclusions

Methods - interventions: - Esomeprazole:

. doses; . time; . other medication;

- tested PPI:. doses;. time;. other medication;

Summary• Rationale• Study question,

aim• Methods

• Study design• Bibliographic

databases• Inclusion and

exclusion criteria• Data to be

extracted• Results• Conclusions

Results

ISI

PUBMED

SCOPUS12

7815

30

142N=214

• Found articlesSummary• Rationale• Study question,

aim• Methods• Results

• Papers selection

• Papers description

• Efficacy • Conclusions

ResultsSummary• Rationale• Study question,

aim• Methods• Results

• Papers selection

• Papers description

• Efficacy • Conclusions

214 articles

99 included

115 excluded

66 found

33 not found

12 include

d54

excludedAge (3)Without Eso (36)Eso Vs placebo (5)With Eso, without comparison (3)PPI in general (3)Metanalysis (2)Evaluates quality of life (1)Evaluation of scales (1)

Included articles

ResultsSummary• Rationale• Study question, aim• Methods• Results

• Papers selection• Papers

description• Efficacy

• Conclusions

* in these studies, the maximum value was not fixed.** in this study, the mean of the ages of the participants was the variable considered

ResultsSummary• Rationale• Study question,

aim• Methods• Results

• Articles • Paper selection: • Included

articles, extracted data

• Efficacy• Conclusions

Efficacy: Esomeprazole 20mg vs. old PPIs

ResultsSummary• Rationale• Study question,

aim• Methods• Results

• Articles • Paper selection: • Included

articles, extracted data

• Efficacy• Conclusions

Efficacy: Esomeprazole 40mg vs. old PPIs

Conclusion

• With this study we found that, in general, Esomeprazole seems to be better at

healing and prevention of mucosal injury

than other PPIs that already exist.

Summary• Rationale• Study question,

aims• Methods• Results• Conclusion

Advisor: Mário Dinis Ribeiro April 18th 2008

Ana LopesAndreia PintoCatarina MeloDiogo DiasIsabel SaavedraJoão MatiasMariana FerreiraMariana Mangas Paula Neves Rita Sapage Rui CoelhoTeresa Caridade Teresa Tavares

Class 161st Year

Introdução à Medicina IIFaculdade de Medicina da Universidade

do Porto