Comparison of four proton pump inhibitors for the short-term treatment of esophagitis in elderly patients

Table 1 Demographic and clinical characteristics of the study population

	All patients	Omeprazole	Lansoprazole	Pantoprazole	Rabeprazole
Number of patients	320	80	80	80	80
Males/Females	156/164	44/36	36/44	39/41	37/43
Mean age (yr)	77.4 ± 7.9	77.9 ± 6.4	77.8 ± 9.2	76.8 ± 6.1	77.0 ± 9.5
Age Range (yr)	65-93	65-93	65-92	65-88	65-93
Esophagitis n (%)
-Grade I°	96 (30.0)	34 (42.5)	26 (32.5)	20 (25.0)	16 (20.0)
-Grade II°	152 (47.5)	27 (33.8)	33 (41.3)	42 (52.5)	50 (62.5)
-Grade III°-IV°	72 (22.5)	19 (23.8)	21 (26.2)	18 (22.5)	14 (27.6)
Hiatus hernia n (%)	194 (60.6)	43 (53.8)	48 (60.0)	50 (62.5)	53 (66.3)
H pylori infection n/n (%)	202/306 (66.0)	52/76 (68.4)	61/76 (80.3)	51/77 (66.2)	38/77 (49.3)
NSAIDs/Aspirin use n (%)	78 (24.4)	18 (22.5)	17 (21.3)	26 (32.5)	17 (21.3)

Table 2 Healing rates, drop-out patients, and side effects in elderly patients divided according to the different PPI regimens

		Per protocol analysis		Intention to treat analysis
Regimen	No. of patients	Cure rates %(N° of patients)	95% CI	Cure rates %(N° of patients)	95% CI	Drop outs	Side effects
Omeprazole	80	81.0	72.0–89.9	75.0	65.0–84.0	6 (7.5)	1
		60/74		60/80
Lansoprazole	80	90.7	84.1–97.2	85.0	77.0-92.8	5 (6.3)	1
		68/75		68/80
Pantoprazole	80	93.51	87.9–99.0	90.01	83.4-96.5	3 (3.8)	1
		72/77		72/80
Rabeprazole	80	94.62	89.4–99.7	88.82	81.5-95.6	5 (6.3)	1
		71/75		71/80
Total	320	90.0	86.6-93.4	84.7	80.7-88.6	19 (5.9)	4
		271/301		271/320			(1.4)

¹Pantoprazole vs Omeprazole: PP analysis: P = 0.039, ITT analysis P = 0.022;

²Rabeprazole vs Omeprazole: PP analysis: P = 0.022, ITT analysis P = 0.040.

Table 3 Healing rates of esophagitis after eight weeks of PPI treatment in elderly patients with esophagitis divided according to the grades of severity of esophagitis according to the Savary-Miller classification

Severity grades	Omeprazole		Lansoprazole		Pantoprazole		Rabeprazole
	n	%	n	%	n	%	n	%
I gradea	27/33	81.8	25/25	100	20/20	100	14/14	100
II gradec	18/22	81.8	28/29	96.5	36/40	90.0	46/48	95.8
III-IV gradese	15/19	78.9	15/21	71.4	16/17	94.1	11/13	84.6

^aP = 0.012;

^cP = 0.215;

^eP = 0.458.

Table 4 Healing rates of esophagitis in elderly patients divided according to H pylori infection

	Omeprazole	Lansoprazole	Pantoprazole	Rabeprazole	All
	(n = 71)	(n = 71)	(n = 74)	(n = 72)	(n = 288)
H pylori positive	38/49	54/57	45/48	33/34	170/188
n = 188	77.6%	94.7%	93.8%	97.1%	90.4%
H pylori negative	19/22	11/14	24/26	35/38	89/100
n = 100	86.4%	78.6%	92.3%	92.1%	89.0%
	Omeprazole	Lansoprazole	Pantoprazole	Rabeprazole	All
	(n = 49)	(n = 57)	(n = 48)	(n = 34)	(n = 188)
H pylori cured	24/32	43/46	39/42	28/29	134/149
n = 149	75.0%	93.5%	92.6%	96.6%	89.9%
H pylori still-positive	14/17	11/11	6/6	5/5	36/39
n = 39	82.4%	100%	100%	100%	92.3%

Table 5 Symptoms in elderly patients with esophagitis before and after two months of PPI therapy

Symptoms	Before therapy	After therapy
	All	Healed	Unhealed	Healed vs unhealed
	n = 301	n = 271	n = 30	P value
Heartburn (n, %)	131 (43.5)	9 (3.3)	6 (20.0)	0.0001
Acid regurgitation (n, %)	39 (13.0)	4 (1.5)	0 (0.0)	0.874
Epigastric pain (n , %)	143 (47.5)	10 (3.7)	2 (6.6)	0.781
Dysphagia (n, %)	10 (3.3)	0 (0.0)	0 (0.0)	--
Vomiting (n, %)	60 (19.9)	0 (0.0)	0 (0.0)	--
Anaemia (n, %)	28 (9.3)	0 (0.0)	0 (0.0)	--

Table 6 Symptom disappearance after therapy in elderly patients divided according to PPI regimens %

	Omeprazole	Lansoprazole	Pantoprazole	Rabeprazole
Heartburn	86.9a	82.4bd	100	100
Acid regurgitation	100	75.0cf	92.2	90.1
Epigastric pain	95	82.6eh	95.2	100
Dysphagia	100	100	100	100
Vomiting	100	100	100	100
Aenemia	100	100	100	100

^aP < 0.05 Omeprazole vs Pantoprazole and Omeprazole vs Rabeprazole;

^bP = 0.0001 Lansoprazole vs Pantoprazole;

^dP = 0.005 Lansoprazole vs Rabeprazole;

^fP = 0.0001 Lansoprazole vs Omeprazole;

^cP < 0.05 Lansoprazole vs Pantoprazole, Lansoprazole vs Rabeprazole;

^eP < 0.05 Lansoprazole vs Omeprazole and Lansoprazole vs Pantoprazole;

^hP = 0.0001 Lansoprazole vs Rabeprazole.