R E V I E W A review of esomeprazole in the treatment of gastroesophageal reﬂux disease (GERD) Evangelos Kalaitzakis Einar Björnsson Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden Correspondence: Evangelos Kalaitzakis Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden Tel +46 31 34 21000 Fax + 46 31 82 21 52 Email evangelos.kalaitzakis@vgregion.se Abstract: Proton-pump inhibitors (PPIs) are the drugs of choice for the treatment of gastroesophageal reﬂux disease (GERD). Esomeprazole is the latest PPI and was developed as the S-isomer of omeprazole as an attempt to improve its pharmacokinetic properties. Esomeprazole has been reported to have a somewhat higher potency in acid inhibition than other PPIs. Despite some controversy, data from clinical trials and meta-analyses indicate that esomeprazole 40 mg od for up to 8 weeks provided higher rates of healing of erosive GERD and a greater proportion of patients with sustained resolution of heartburn, than omeprazole 20 mg, lansoprazole 30 mg, or pantoprazole 40 mg od. Esomeprazole 20 mg od has also been shown to be more effective in maintaining healing of erosive GERD compared with lansoprazole 15 mg od or pantoprazole 20 mg od. However, it is not clear whether these statistically signiﬁcant differences are of major clinical importance. Esomeprazole 20 mg od is superior to placebo for treatment of non-erosive reﬂux disease (NERD) but clinical trials have not shown any signiﬁcant differences in efﬁcacy between esomeprazole 20 mg and omeprazole 20 mg or pantoprazole 20 mg od. Lastly, although esomeprazole treatment in GERD has been reported to result in improvement of health-related quality of life (QoL) indices, no clinical trials have evaluated the possible differential effects of different PPIs on QoL in GERD. Keywords: esomeprazole, gastro-esophageal reﬂux disease (GERD), esophagitis, proton pump inhibitors Introduction Gastro-esophageal reﬂux (GERD) is deﬁned as the reﬂux of gastric contents into the esophagus leading to reﬂux symptoms sufﬁcient to affect patient well-being and/or cause complications (Vakil et al 2006). Population-based studies suggest that heartburn is a very common symptom in the general population with a prevalence of 10%–20% in the Western world but far from all are consulters. However, in Asia the prevalence of GERD-like symptoms is lower and has been reported to be less than 5% (Dent et al 2005; Moayyedi and Talley 2006). When traditional endoscopy is used, GERD can be subdivided into reﬂux esophagitis (or erosive GERD) and endoscopy-negative reﬂux disease (or non-erosive reﬂux disease, NERD) (Moayyedi and Talley 2006; Vakil et al 2006). About 50% of patients with the disease have a normal endoscopy in referral centers (Johansson et al 1986; Johnsson et al 1987), but in primary care the occurrence of esophagitis is lower (Vakil et al 2006). Erosive GERD has been associated with complications such as esophageal strictures and Barrett’s esophagus (Vakil et al 2006). The proton pump inhibitors (PPIs) are substituted benzimidazoles administered as enteric-coated tablets or capsules that pass through the stomach and are absorbed in the duodenum. They act on the proton pump molecule on the luminal surface of gastric parietal cells, resulting in inhibition of acid secretion (Hatlebakk 2003). Esomeprazole is the latest PPI and was developed as the S-isomer of omeprazole as an improvement Therapeutics and Clinical Risk Management 2007:3(4) 653–663 © 2007 Dove Medical Press Limited.All rights reserved 653