Efficacy Of Proton Pump Inhibitor For Healing Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a disease that caused by thereflux of the mixed material in stomach and duodenum which manifests a serialof chronic symptoms characterized pathologically by damage of membrane ofesophagus. Gastro-oesophageal reflux disease (GERD) is a common disorderusually diagnosed by the presence of heartburn and acid regurgitation and/or thepresence of oesophageal lesions.Patient with GERD usually have lowerefficiency, quality of life and health status.The seriousness of GERD is directlyconcert to the degree and time of the exposure of esophagus to the sourregurgitation. Proton pump inhibitors are one of the most effective clinicalmedicines. Five proton pump inhibitors are now available for the treatment ofacid-related disorders (omeprazole, lansoprazole, rabeprazole, pantoprazole andesomeprazole).Now with the development of evidence-based medicine (EBD),clinicians should combine clinical practice and experiencement with objectiveresearch, then make the most perfect diagnosis, secure therapeutics and preciseprognosis estimate for every specific patient. It is defferent from traditionalmedicine. Traditional medicine depends on experiencements,while EBD isestablished on the best evidence of studis. There is no systemaic review tosummarize the comparison of efficacy of esomeprazole vs. the other protonpump inhibitors for the initial treatment of gastro-oesophageal reflux disease(GERD) .So a search of the medical literature was performed to identify anyconsistent evidence of differences in outcomes between agents or doses withinthis class of drugs.then we can provide scientific evidence for doctors.Material and methods A search of the medical literature was performed intwo electronic databases, and randomized controlled trials of higher quality wereincluded in the assessment. A search of the on-line bibliographic databaseswanfangdata and PUBMED was performed to identify articles publishedbetween 1988 and 2006, using the terms proton pump inhibitor, lansoprazole,esomeprazole, rabeprazole, omeprazole, pantoprazole, and gastrooesophagealreflux disease (GERD). Bibliographies from all potentially relevant articles werealso manually searched. Studies were selected if they met the internalizecriteria. In the end, we got 7 chapters. Study quality was assessed using theJadad scale. All selected studies were classified as being of 'high quality'.Following abstraction of the data, a spreadsheet was constructed and analysedwith regard to the outcomes of the various comparisons between the protonpump inhibitors (GERD and ulcer healing or symptom relief studies, qualityscores of the studies, etc.) that had been pre-determined to be of clinicalimportance. Studies of high-quality design and with clinically relevantend-points that directly compared the efficacy of two or more proton pumpinhibitors or doses of proton pump inhibitors in parallel were sufficient todetermine whether meaningful clinical differences in outcomes occurred withinthe proton pump inhibitor class or dose range. We deal with these Materialsstatistical treatment and combine them by Meta-analysis. At last we useintention-to-treat (ITT) analysis with the outcomes of every group.These studiesideally should follow evidence-based methodology, i.e. should be randomizedusing concealed allocation techniques, should be double-blind, should beanalysed by an intention-to-treat method, should have complete accounting ofall patients entered into the trial and should be of a sufficient size in order tominimize bias and to ensure that the results obtained are reliable and valid. Thehigh quality of evidence for a particular focused clinical question was then thesafeguard of review's confidence.Results Using the above search strategy, 7 English citations on protonpump inhibitors as a general term were identified. Most of the patients are whitepeople. Esomeprazole 40 mg provides more effective intragastric acid controlthan lansoprazole 30 mg (P<0.05) , pantoprazole 40 mg (P<0.001 ) andrabeprazole 20 mg (P<0.01) in patients with gastro-oesophageal reflux disease.Standard-dose esomeprazole was more effective than standard-dose omeprazoleand lansoprazole in GERD symptom relief in these studies. Low-doseesomeprazole was not superior than Standard-dose omeprazole in relievingheartburn symptoms in the trials. The study also demonstrated the superiority ofesomeprazole 40 mg vs. lansoprazole 30 mg and omeprazole 20mg in thehealing of oesophagitis. The safety and tolerability profile was similar for allPPIs studied.Discussion The predominance of Esomeprazole for GERD can be listed asfollow: â‘  High systemic bioavailability: Esomeprazole (Nexium), the S-isomerof omeprazole, is the first proton pump inhibitor to be developed as a singleoptical isomer. Following oral administration, esomeprazole displays highersystemic bioavailability than omeprazole, providing more effective control of24-h intragastric acidity in patients with symptoms of gastro-oesophageal refluxdisease (GERD). In clinical studies, esomeprazole has been shown to providefaster symptom resolution and more complete healing than omeprazole inGERD patients with erosive oesophagitis By comparison, the metabolism ofesomeprazole appears to be dependent less on hydroxylation via CYP2C19 andmore on sulphoxidation via the CYP isoform CYP3A4. The shape of the plasmaconcentration vs time curve is largely determined by the relation between thearea under the plasma concentration vs time curve (AUC) and the maximumplasma concentration.The AUC variation of Esomeprazole 40mgis more littlethan Esomeprazole 20 mg and omeprazole 20 mg. â‘¡Specific action to protonpump: The target for esomeprazole is the proton pump in parietal cells. Thecompound accumulates in the acidic compartment of the parietal cells, wherethe molecule is transformed to its active form, the sulphenamide, whichproduces a profound suppression of gastric acid secretion by irreversible bindingand blocking of the H+/K+ adenosine triphosphatase (ATPase), the proton pump.Because AUC of Esomeprazole is higher than omeprazole, it can provide moreeffective intragastric acid control than others. â‘¢ More effective intragastric acidcontrol: The inhibitory action to gastrodiagnost of ESO have dose dependent.Itincreases as we give the medicine again. â‘£ Selectivity: Esomeprazole select theacidic compartment of the parietal cells accurately, so we can use it without anyworry as we use omeprazole .Conclusions Standard-dose Esomeprazole should be a treatment of choicefor patients with moderate to GERD if healing and heartburn relief are theprimary goals of therapy. â‘  Esomeprazole is the first proton pump inhibitor tobe developed as a single optical isomer.It has high systemic bioavailability. Datafrom this study show that Eso 40 mg once daily heals GERD faster. Furthermore,esomeprazole resolved heartburn, the most commonly reported symptom ofGERD, in a significantly higher proportion of patients than other PPI. â‘¡ Esohas the same safety as ome as we expected.