Esomeprazole in GERD Table 2 Randomized trials evaluating the efﬁcacy of esomeprazole vs other proton-pump inhibitors in healing erosive GERD Reference Study design Number of PPIs compared Healing rates intention-to-treat analysis patients 4 weeks 8 weeks Kahrilas et al 2000 Double-blind, 1960 Eso40 vs eso20 vs 75.9% vs 70.5% vs 64.7%, 94.1% vs 89.9% vs 86.9%, randomized ome20 od p < 0.05 for eso40 vs p < 0.05 for all comparisons p = 0.09 for eso20 vs ome20 Richter et al 2001 Double-blind, 2425 Eso40 vs ome20 od 81.7% vs 68.7%, p < 0.001 93.7% vs 84.2%, p < 0.001 randomized Schmitt et al 2006 Double-blind, 1148 Eso40 vs ome20 od 68.2% vs 66.3%, p = 0.385 87% vs 85.8, p = 0.552 randomized Castell et al 2002 Double-blind, 5241 Eso40 vs lan30 od 79.4% vs 75.1%, p < 0.05 92.6% vs 88.8%, p < 0.0001 randomized Howden et al 2002 Double-blind, 284 Eso40 vs lan30 od 78.3% vs 77%, p > 0.05 91.4% vs 89.1, p > 0.05 randomized Fennerty et al 2005 Double-blind, 1001 Eso40 vs lan30 od 55.8% vs 47.5%, p = 0.005 82.4% vs 77.5%, p = 0.005 randomized Gillessen et al 2004 Double-blind, 227 Eso40 vs panto40 od 72% vs 74%, p > 0.05a 92% vs 90%, p > 0.05b randomized Labenz et al 2005b Double-blind, 3170 Eso40 vs panto40 od 81% vs 74.5%, p < 0.001 92% vs 95.5%, p < 0.001 randomized aHealing rates regarding the ﬁrst follow-up visit at 4 or 6 weeks in this study bHealing rates at the second follow-up visit at 8 or 10 weeks in this study Notes: No randomized studies comparing esomeprazole with rabeprazole for healing erosive GERD were found. Abbreviations: Eso, esomeprazole; ome, omeprazole; lan, lansoprazole; panto, pantoprazole; PPI, proton-pump inhibitor. H. pylori-infected patients may be associated with improved symptom control and more rapid healing of the esophagitis (Holtmann et al 1999). Furthermore, H. pylori eradication has been reported to be a predictor of failure in the treatment of GERD with omeprazole 20 mg od (Wu et al 2004) but this ﬁnding was not reproduced in another study (Kuipers et al 2004). A recent review on this topic concluded that at present it is unclear whether H. pylori should be eradicated in GERD patients (Delaney and McColl 2005). In all of the studies reviewed here H. pylori status was evaluated in the patients included. A signiﬁcant effect of H. pylori infection was shown in one of the studies comparing esomeprazole 40 mg with pantoprazole 40 mg od with H. pylori-negative patients experiencing lower healing rates than in H. pylori-positive patients (Labenz et al 2005b). No difference was observed in the efﬁcacy of esomeprazole between H. pylori-negative and H. pylori-positive GERD patients in the studies where this was investigated (Kahrilas et al 2000; Richter et al 2001; Castell et al 2002; Gillessen, et al 2004; Fennerty et al 2005; Labenz et al 2005b; Schmitt et al 2006). However, it should be taken into consideration that the effect of H. pylori sta- tus on healing of erosive esophagitis was only a secondary endpoint in these studies. Five meta-analyses on the effect of different PPIs were identiﬁed (Edwards et al 2001, 2006; Klok et al 2003; Vakil and Fennerty 2003; Gralnek et al 2006), three of Therapeutics and Clinical Risk Management 2007:3(4) which focused on the effect of different PPIs (including esomeprazole) in healing erosive esophagitis (Edwards et al 2001, 2006; Gralnek, et al 2006). In a recent meta-analysis comparing the efﬁcacy of PPIs in short-term use (Klok et al 2003), two studies evaluating healing rates with esomeprazole 40 mg vs omeprazole 20 mg od were included (Kahrilas et al 2000; Richter et al 2001). The authors concluded that esomeprazole was superior to omeprazole (relative risk, 1.18; 95% CI 1.14–1.23) (Klok et al 2003). Another meta-analysis comparing the efﬁcacy of PPIs in the management of GERD and peptic ulcer disease (Vakil and Fennerty 2003) included three studies comparing esomeprazole 40 mg od with either omeprazole 20 mg od (Kahrilas et al 2000; Richter et al 2001) or lansoprazole 30 mg od (Castell et al 2002). The authors concluded that esomeprazole was superior to both the PPIs with which it was compared in healing of erosive esophagitis and in speed of symptom relief (Vakil and Fennerty 2003). In a meta-analysis of the efﬁcacy of PPIs in acute treatment of reﬂux esophagitis (Edwards et al 2001), three studies comparing esomeprazole 40 mg with omeprazole 20 mg od were included. Two of these were taken into consideration in the current review as well (Kahrilas et al 2000; Richter et al 2001) but Edwards et al (2001) also used data on ﬁle from the manufacturer of esomeprazole. They concluded that esomeprazole demonstrated higher healing rates 657