Comparative Efficacy of Rabeprazole and Pantoprazole in the Control of Nocturnal Gastric Acid Output and Intragastric Acidity—A Randomized, Two-Way Crossover Study

Abstract

Purpose: Rabeprazole and other proton pump inhibitors (PPI) have been shown to be highly effective in the treatment of gastro-esophageal reflux disease (GERD). However, there has never been a rigorous investigation as to the comparative ability of PPIs when taken as per FDA label to control night-time GERD. In this study, we sought to evaluate the relative efficacies of rabeprazole and pantoprazole in controlling nocturnal gastric acid secretion. Methods: The study was conducted as a double-blinded, randomized crossover study enrolling 23 patients with a history of GERD without previous PPI treatment. The patients first underwent a baseline 12 hour overnight gastric analysis (2000 to 0800) whereby 30 minute samples were collected and assessed for acid output and intragastric pH. The subjects were randomized into 1 of 2 groups to receive either rabeprazole 20 mg or pantoprazole 40 mg on the morning of the next visit (Treatment 1). At that time, a second gastric analysis was completed in the above fashion. Following a 4 week washout, the subjects were given the other study drug (Treatment 2) and a third gastric analysis was completed. Acid output was determined using the titration method. Nocturnal acid breakthrough (NAB) was defined as persistence of gastric pH < 4 for greater than 1 hour between the hours of 22:00 and 06:00. Results: Rabeprazole achieved greater evening and nocturnal acid control compared with pantoprazole (median pH: 4.2 vs 3.9; mean time pH > 4: 5.5 vs 4.5 hours; NAB 50% vs 67%). A significantly greater percentage of patients on rabeprazole maintained an intragastric pH greater than 4.0 for more than 6 hours compared to pantoprazole (47% vs 27%). Rabeprazole achieved greater acid output control compared to pantoprazole (mean acid output:.78 vs 1.18 mEq/hr (p <.005); mean percentage of time acid output < 2: 92% vs 78%). Conclusions: Rabeprazole achieved significantly greater control of evening and night-time acid output, suggesting that it is a highly effective treatment for night-time GERD. In addition, a significantly greater percentage of patients on rabeprazole maintained an intragastric pH > 4 for more than half the study time with fewer incidences of NAB. These results demonstrate for the first time that control of nocturnal gastric acid secretion can be improved with rabeprazole compared to pantoprazole.