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Proton-pump inhibitors (PPIs) form the recognized cornerstone of therapy for gastroesophageal reflux disease (GERD). Sustained maintenance of pH higher than 4 has correlated with prompt resolution of GERD symptoms and high rates of esophagitis healing. To date, none of the newer PPIs -- lansoprazole, rabeprazole, or pantoprazole -- have proven significantly better than omeprazole at maintaining pH higher than 4, when clinically relevant endpoints were used. Compared with omeprazole, its S-isomer (esomeprazole) displays lower first-pass hepatic metabolism and slower plasma clearance; this results in higher plasma concentration and highly effective inhibition of gastric acid secretion.
In a double-blind, crossover study, Swedish investigators …