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Relationship Between Healing of Erosive Esophagitis and Percent Time with Intragastric pH>4


Kahrilas, Peter MD*; Levine, Doug MD; Röhss, Kerstin PhD; Åstrand, Magnus PhD; Junghard, Ola PhD; Lind, Tore MD

American Journal of Gastroenterology: September 2008 - Volume 103 - Issue - p S17–S18
Supplement Abstracts Submitted for the 73rd Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS

Feinberg School of Medicine, Northwestern University, Chicago, IL, AstraZeneca, Wilmington, DE, AstraZeneca R&D, Mölndal, Sweden.

Purpose: The relationship between intragastric acid suppression and healing of erosive esophagitis (EE) has long been recognized based on comparisons of histamine-2 receptor antagonists and omeprazole (Digestion 1992;51 Suppl 1:59–67). We sought to advance these observations using data from published studies using two different proton pump inhibitors.

Methods: EE healing and pH data were obtained from two independent studies (Aliment Pharmacol Ther 2000;14:1249–58; Aliment Pharmacol Ther 2000;14:861–7). Both studies used treatment arms of once-daily dosing regimens of omeprazole 20 mg, and esomeprazole 20 mg and 40 mg. A linear model, μ = α + βγ, of EE healing rate (μ) and mean time (γ) with intragastric acid control (pH > 4) was fitted to data after 4 and 8 weeks of treatment. The variability of both data sources were taken into account, and 95% confidence intervals were calculated for α (intercept) and b (slope coefficient).

Results: The slope coefficient (b) was significant at 4 and 8 weeks (P < .002), indicating a significant positive relationship between EE healing at these time points and percent time with intragastric pH > 4 (within the range of 45% to 70%) (Figure). Once-daily dosing with esomeprazole 40 mg provided greater time with intragastric pH > 4 and, thus, greater EE healing than esomeprazole 20 mg, which was more effective than omeprazole 20 mg. Apart from intragastric pH control, duration of treatment was also a dominant determinant of healing rate.



Conclusion: This statistical examination demonstrates that increased time with intragastric pH > 4 correlates with higher EE healing rates at both 4 and 8 weeks in patients with all pre-treatment severity grades of EE.

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