Esomeprazole provides improved acid control vs. omeprazole in patients with symptoms of gastro‐oesophageal reflux disease

Background: Esomeprazole (Nexium) is a new proton pump inhibitor for the treatment of acid‐related diseases. Methods: In this double‐blind crossover study, 38 patients with gastro‐oesophageal reflux disease (GERD) symptoms were randomized to esomeprazole 40 and 20 mg and omeprazole 20 mg once daily for 5 days. On day 5 of each dosing period, 24‐h intragastric pH and pharmacokinetic variables were measured. Results: Thirty‐six patients aged 29–58 (mean 45) years completed the study. Esomeprazole 40 and 20 mg maintained intragastric pH > 4 for (mean) 16.8 and 12.7 h, respectively, vs. 10.5 h for omeprazole 20 mg ( P < 0.001 and P < 0.01). Twenty‐four‐hour median intragastric pH was significantly higher with esomeprazole 40 mg (4.9) and 20 mg (4.1) than with omeprazole 20 mg (3.6) ( P < 0.001 and P < 0.01). Area under the plasma concentration–time curve ( AUC ) was 80% higher for esomeprazole 20 mg vs. omeprazole, while that for esomeprazole 40 mg was more than five times higher (each P < 0.0001). Interpatient variability in intragastric pH and AUC was less with esomeprazole than with omeprazole. Esomeprazole was well tolerated and there were no safety concerns. Conclusions: Esomeprazole provides more effective acid control than omeprazole, with reduced interpatient variability, thereby offering the potential for improved efficacy in acid‐related diseases.