Standard doses of the oral proton pump inhibitors are clinically equivalent: A comparison

Abstract

Five proton pump inhibitors (PPIs)—esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole—are currently marketed throughout the world. As a therapeutic group, the PPIs are highly useful for the relief of symptoms and healing of gastroesophageal reflux disease (GERD), gastric and duodenal ulcer disease, eradication of Helicobacter pylori infection, prevention and treatment of damage associated with use of NSAIDs, management of hypersecretory states such as Zollinger-Ellison syndrome, and care of patients with nonvariceal upper gastrointestinal bleeding or nonulcer dyspepsia. The pathophysiologic basis of these benefits lies in the PPIs’ potent inhibitory effects on gastric acid. The PPIs differ in pharmacokinetics, pharmacodynamics, interactions with food and antacids, clinical efficacy, and potential for drug interactions. These variations are often subtle and it is not always clear whether they are clinically important. The differences do not appear to be clinically important with regard to symptom response or healing rates in persons with GERD. The choice of one PPI over another must depend on each physician’s interpretation of the clinical importance of these differences, each drug’s approval for treatment of specific clinical indications within the physician’s practice jurisdiction, the strength of the evidence based on clinical trials, and the cost of each PPI.