Esomeprazole Versus Other Proton Pump Inhibitors in Erosive Esophagitis: A Meta-Analysis of Randomized Clinical Trials
There are limited data comparing the effectiveness of available proton pump inhibitors (PPIs) in erosive esophagitis (EE). We performed a meta-analysis to calculate the pooled effect of esomeprazole on healing rates, symptom relief, and adverse events versus competing PPIs in EE. Methods: We performed a structured electronic search of MEDLINE and EMBASE and reviewed published abstracts to identify English-language, randomized clinical trials from 1995–2005, comparing rates of endoscopic healing, symptom relief, and adverse events with esomeprazole versus alterna- tive PPIs in the treatment of gastroesophageal reﬂux disease (GERD)/EE. We then performed meta-analysis to compare the relative risk (RR) of EE healing, symptom relief, and adverse events between study arms and calculated the abso- lute risk reduction and number needed to treat (NNT) for each outcome. Results: Meta-analysis was performed on 10 studies (n 15,316). At 8 weeks, there was a 5% (RR, 1.05; 95% conﬁdence interval, 1.02–1.08) relative increase in the probability of healing of EE with esomeprazole, yielding an absolute risk reduction of 4% and NNT of 25. The calculated NNTs by Los Angeles grade of EE (grades A–D) were 50, 33, 14, and 8, respectively. Last, esomeprazole conferred an 8% (RR, 1.08; 95% conﬁdence interval, 1.05–1.11) relative in-crease in the probability of GERD symptom relief at 4 weeks.
As compared with other PPIs, esomeprazole confers a statistically signiﬁcant improvement, yet, clinically, only a modest overall beneﬁt in 8-week healing and symptom relief in all-comers with EE. The clinical beneﬁt of esome- prazole appears negligible in less severe erosive disease but might be important in more severe disease.
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