Esomeprazole Versus Other Proton Pump Inhibitors in Erosive Esophagitis: A Meta-Analysis of Randomized Clinical Trials

Background & Aims: There are limited data comparing the effectiveness of available proton pump inhibitors (PPIs) in erosive esophagitis (EE). We performed a meta-analysis to calculate the pooled effect of esomeprazole on healing rates, symptom relief, and adverse events versus competing PPIs in EE. Methods: We performed a structured electronic search of MEDLINE and EMBASE and reviewed published abstracts to identify English-language, randomized clinical trials from 1995–2005, comparing rates of endoscopic healing, symptom relief, and adverse events with esomeprazole versus alternative PPIs in the treatment of gastroesophageal reflux disease (GERD)/EE. We then performed meta-analysis to compare the relative risk (RR) of EE healing, symptom relief, and adverse events between study arms and calculated the absolute risk reduction and number needed to treat (NNT) for each outcome. Results: Meta-analysis was performed on 10 studies (n = 15,316). At 8 weeks, there was a 5% (RR, 1.05; 95% confidence interval, 1.02–1.08) relative increase in the probability of healing of EE with esomeprazole, yielding an absolute risk reduction of 4% and NNT of 25. The calculated NNTs by Los Angeles grade of EE (grades A–D) were 50, 33, 14, and 8, respectively. Last, esomeprazole conferred an 8% (RR, 1.08; 95% confidence interval, 1.05–1.11) relative increase in the probability of GERD symptom relief at 4 weeks. Conclusions: As compared with other PPIs, esomeprazole confers a statistically significant improvement, yet, clinically, only a modest overall benefit in 8-week healing and symptom relief in all-comers with EE. The clinical benefit of esomeprazole appears negligible in less severe erosive disease but might be important in more severe disease.

Abbreviations used in this paper: ARR, absolute risk reduction, CI, confidence interval, EE, erosive esophagitis, GERD, gastroesophageal reflux disease, NNT, need to treat, PPI, proton pump inhibitor, RR, relative risk