Clinical Research
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 7, 2007; 13(33): 4467-4472
Published online Sep 7, 2007. doi: 10.3748/wjg.v13.i33.4467
Comparison of four proton pump inhibitors for the short-term treatment of esophagitis in elderly patients
Alberto Pilotto, Marilisa Franceschi, Gioacchino Leandro, Carlo Scarcelli, Luigi Piero D’Ambrosio, Francesco Paris, Vito Annese, Davide Seripa, Angelo Andriulli, Francesco Di Mario
Alberto Pilotto, Marilisa Franceschi, Carlo Scarcelli, Luigi Piero D’Ambrosio, Francesco Paris, Davide Seripa, Geriatric Unit, Department of Medical Sciences & Gerontology and Geriatrics Laboratories, Department of Research, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy
Marilisa Franceschi, Francesco Di Mario, Gastroenterology Department, University of Parma, Parma, Italy
Gioacchino Leandro, Gastroenterology Unit, IRCCS De Bellis, Castellana Grotte, Bari, Italy
Angelo Andriulli, Vito Annese, Gastroenterology Unit, Department of Medical Sciences, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy
Author contributions: All authors contributed equally to the work.
Supported by “Ministero della Salute”, IRCCS Research Program, Ricerca Corrente 2006-2008, Linea n. 2 “Malattie di rilevanza sociale”
Correspondence to: Alberto Pilotto, Geriatric Unit, IRCCS "Casa Sollievo della Sofferenza", Viale Cappuccini, 71013 San Giovanni Rotondo (FG), Italy. alberto.pilotto@operapadrepio.it
Telephone: +39-882-410271 Fax: +39-882-410271
Received: May 16, 2007
Revised: June 1, 2007
Accepted: June 4, 2007
Published online: September 7, 2007
Abstract

AIM: To compare efficacy and tolerability of four proton pump inhibitors (PPIs) commonly used in the short-term therapy of esophagitis in elderly patients.

METHODS: A total of 320 patients over 65 years with endoscopically diagnosed esophagitis were randomly assigned to one of the following treatments for 8 wk: (1) omeprazole 20 mg/d; (2) lansoprazole 30 mg/d; (3) pantoprazole 40 mg/d, or (4) rabeprazole 20 mg/d. Major symptoms, compliance, and adverse events were recorded. After 8 wk, endoscopy and clinical evaluation were repeated.

RESULTS: Per protocol and intention to treat healing rates of esophagitis were: omeprazole = 81.0% and 75.0%, lansoprazole = 90.7% (P = 0.143 vs omeprazole) and 85.0%, pantoprazole = 93.5% (P = 0.04 vs omeprazole) and 90.0% (P = 0.02 vs omeprazole), rabeprazole = 94.6% (P = 0.02 vs omeprazole) and 88.8% (P = 0.04 vs omeprazole). Dividing patients according to the grades of esophagitis, omeprazole was significantly less effective than the three other PPIs in healing grade 1 esophagitis (healing rates: 81.8% vs 100%, 100% and 100%, respectively, P = 0.012). Pantoprazole and rabeprazole (100%) were more effective vs omeprazole (89.6%, P = 0.0001) and lansoprazole (82.4%, P = 0.0001) in decreasing heartburn. Pantoprazole and rabeprazole (92.2% and 90.1%, respectively) were also more effective vs lansoprazole (75.0%, P < 0.05) in decreasing acid regurgitation. Finally, pantoprazole and rabeprazole (95.2% and 100%) were also more effective vs lansoprazole (82.6%, P < 0.05) in decreasing epigastric pain.

CONCLUSION: In elderly patients, pantoprazole and rabeprazole were significantly more effective than omeprazole in healing esophagitis and than omeprazole or lansoprazole in improving symptoms. H pylori infection did not influence the healing rates of esophagitis after a short-term treatment with PPI.

Keywords: Elderly; Esophagitis; Proton pump inhibitors