questionnaires (Kulig et al 2003). At baseline, QoL in GERD patients was lower than in the general population but within 2 weeks, after treatment with esomeprazole, both symptoms and QoL improved in all subscales (Kulig et al 2003). Recently a large randomized study evaluated the long-term effect of two maintenance treatment modalities with esome- prazole in non-erosive and mild erosive GERD (Pace et al 2005). Altogether, 6017 patients with GERD symptoms (max grade I esophagitis according to Savary-Miller’s classiﬁcation at baseline endoscopy) received acute treatment with esome- prazole 40 mg od for 4 weeks. If successfully treated, they were randomized to either esomeprazole 20 mg od or esome- prazole 20 mg on demand for 6 months. Health-related QoL was measured with validated questionnaires at baseline as well as at the start and conclusion of the maintenance period. At baseline, GERD patients had profound reductions in QoL indices but after acute esomeprazole treatment for 4 weeks all QoL dimensions showed statistically signiﬁcant (p < 0.0001) improvements. A statistically signiﬁcant difference in QoL scores was registered at the end of the maintenance phase in favor of the continuous regimen (Pace et al 2005). Lastly, a study from Norway assessed the efficacy of three treatment regimens in improving health-related QoL in patients with GERD symptoms (Hansen et al 2006). Following a 4-week symptom-control phase (esomeprazole 40 mg od), patients were randomized to 6 months’ esomeprazole 20 mg od continuously (n = 658), esomeprazole 20 mg od on-demand (n = 634), or ranitidine 150 mg bd continuously (n = 610). Health-related QoL was assessed by means of validated questionnaires at baseline as well as at the start and conclusion of the maintenance period. Esomeprazole 40 mg od improved QoL during the acute symptom-control phase. At 6 months, both esomeprazole regimens were more effective than ranitidine in all dimensions of QoL (p < 0.0001). However, esomeprazole 20 mg od continuously maintained QoL better than esomeprazole on demand and was associated with greater patient satisfaction (Hansen et al 2006). Thus, there are data to support that esomeprazole treat- ment is associated with improvement in health-related QoL indices in patients with GERD, at least compared with raniti- dine. However, double-blind, randomized studies comparing the effect of esomeprazole with that of other PPIs on QoL indices at GERD treatment are lacking. Conclusion In patients with gastroesophageal reﬂux disease, standard doses of esomeprazole maintain intragastric pH above 4 Therapeutics and Clinical Risk Management 2007:3(4) Esomeprazole in GERD for signiﬁcantly longer periods compared with standard doses of other PPIs after 5 days of treatment. Despite some controversy, data from clinical trials and meta-analyses indicate that esomeprazole 40 mg od for up to 8 weeks provides 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 to lansoprazole 15 mg od or pantoprazole 20 mg od. However, it is not clear whether these statistically signiﬁcant differences are of major clinical importance. Comparative efﬁcacy studies are also lacking between esomeprazole and rabeprazole in healing and maintenance of healed erosive GERD as well as between esomeprazole and omeprazole or rabeprazole in maintenance of healed erosive GERD. Esomeprazole 20 mg od is superior to placebo for treatment of 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 in this group of patients. No comparative data between esomeprazole and lansoprazole or rabeprazole in NERD could be identiﬁed. Lastly, although esomeprazole treatment in GERD has been reported to result in improve- ment of health-related QoL indices, no clinical trials have evaluated the possible differential effects of different PPIs on QoL in patients treated for GERD. Abbreviations GERD, Gastro-esophageal reﬂux disease; NERD, non-erosive reﬂux disease; PPIs, proton pump inhibitors; QoL, quality of life; CI, conﬁdence interval. References Armstrong D, Talley NJ, Lauritsen K, et al. 2004. The role of acid suppression in patients with endoscopy-negative reflux disease: the effect of treatment with esomeprazole or omeprazole. Aliment Pharmacol Ther, 20:413–21. 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