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Speed of onset of oesophageal acid reduction with different proton‐pump inhibitors in patients with reflux oesophagitis

Objective Proton-pump inhibitors are the most effective drug treatment for gastro-oesophageal reflux disease. With the increasing trend toward 'on demand' therapy, it is important to determine how quickly oesophageal acid reflux is reduced, and whether this differs between the available compounds. Design A 2 x 2 double-blind crossover study. Method Eight patients with Savary-Miller grade II oesophagitis underwent 24 h pre-treatment oesophageal pH monitoring. Each patient was randomly allocated to receive daily omeprazole 20 mg and lansoprazole 30 mg for 2 days, in two separate double-blind periods, with a washout period of 14 days. Two further oesophageal pH recordings were obtained during the second 48 h period of treatment with each drug. Results Five patients completed the study and their results are presented. Lansoprazole significantly reduced the percentage of total reflux time (P=0.04) and percentage upright reflux time (P = 0.04) on the second day of treatment compared to the pre-treatment, while this was not achieved with omeprazole. There was a significant difference in the reduction of the total reflux time (P=0.011), upright reflux time (P = 0.021) and total reflux episodes (P < 0.001) on day 2 of treatment when comparing lansoprazole with omeprazole. All patients on lansoprazole had a decrease in symptoms of heartburn and regurgitation, with complete resolution in four patients. Three patients had a decrease in these symptoms with omeprazole, including complete resolution in two. Conclusion This study was limited by the small number of patients who underwent this demanding investigation. However, lansoprazole appears to have a more rapid onset of reduction of acid gastro-oesophageal reflux than omeprazole over a 48 h period.