In patients with Gastroesophageal Reflux Disease is Esomeprazole the most effective proton pump...

In patients with Gastroesophageal Reflux

Disease is Esomeprazole

the most effective proton pump inhibitor

to induce mucosal healing and/or to maintain it?

Introdução à Medicina II Class 16

Summary• Rationale

• GERD• PPIs• Esomeprazole

• Study question, aims

• Methods• Results• Conclusion• Website

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.





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.





Study question

• Is Esomeprazole more effective in healing mucosal injury and/or in maintaining it, relatively to Omeprazole, Lansoprazole, Rabeprazole, Pantoprazole, in GERD patients? Aims

• To compare efficacy of Esomeprazole relatively to others PPIs in:

inducing mucosal healingmaintaining it

in GERD patients.

Summary• Rationale• Study question,

aims• Methods• Results• Conclusion• Website

• Study design Systematic review.

• Bibliographic databases

Medline (http://www.nlm.nih.gov/medlineplus/)

Scopus (http://www.scopus.com/)

ISI Web of Knowledge

(http://isiwebofknowlegde.com/)


aims• Methods

• Study design• Bibliographic

databases• Inclusion and

exclusion criteria and articles’ evaluation

• Data to be extracted

• Results• Conclusion• Website

Methods

• 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.

• Quality’s evaluation of the articles, using an approved checklist - CONSORT


aims• Methods





• Results• Conclusion

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);


aims• Methods



exclusion criteria and articles' evaluation



Methods - interventions: - Esomeprazole:

. doses; . time;

. other medication; - tested PPI:

. doses;

. time;

. other medication;


aims• Methods






Results

ISI

PUBMED

SCOPUS12

7815

30

142N=214

• Found articlesSummary• Rationale• Study question,

aims• Methods• Results

• Papers’ selection

• Papers’ description

• Forest Plots • Conclusion• Website

ResultsSummary• Rationale• Study question,





214 articles

99 included

115 excluded

66 with link to full

text

33 without link to full

text

12 include

d

54 excluded

Age (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)






Quality assessement: CONSORT

[17, 19] – 6

articles

[20, 22] – 6

articles

Included articles



• Papers’ selection• Papers’

description• Forest Plots

• Conclusion• Website

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



• Papers’ selection:

• Included articles, extracted data

• Forest Plots• Conclusion• Website

Is Esomeprazole (40mg) better in HEALING?



• Papers’ selection:

• Included articles, extracted data

• Forest Plots• Conclusion• Website

Is Esomeprazole (20mg) better in MAINTENANCE?

Conclusion

Esomeprazole seems to be better at

• healing mucosal injury

Pantoprazole (statistically

significant)

•maintenance

Lanzoprazole (statistically significant)



WebsiteSummary• Rationale• Study question,


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

In patients with Gastroesophageal Reflux Disease is Esomeprazole the most effective proton pump...

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