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Western SydneyUniversityComparision of Esomeprazole with Other ProtonPump Inhibitors in Management of GERDAssociated ComplicationsLiterature ReviewYour NameAugust 2021Abstractgastroesophageal reflux disease or in short GERD is a common disorder thatoccurs when gastric acids back flow from the stomack to the aesophagus.This backflow results to irritation, sometimes mild and sometimes extreme.GERD is commonly referred to as a heartburn.This condition can be prevented by reducing theamount of gastric juices produced in the stomach.Some of the drugs used to do thisare the proton pump inhibitor and esomeprazole. There is no doubt that this drugshelp mitigate the effects of GERD but are they safe and if not , which of them issafer?Key words: GERD: Gastro esophageal reflux diseases, PPI’s: proton pump Inhibitors,Esomeprazole, Omeprazole, Pantoprazole, Lansoprazole, erosive esophagitis,Signature: Date:1Contents1 Background 12 Materials and Methods 23 Literature Review 34 Summary and Conclusions 41 BackgroundGastroesophageal Reflux Diseases or GERD commonly known as heart burn is a digestivedisorder that occurs when there is reflux of materials in the stomach such as food andgastric juices to the aesophagus. It happens when the lower esophagael sphincter (shownbelow) opens up and consequently lets in materials into the esophagus(? ).Generally,this often results into various signs and symptoms which are collectively and commonlyreferred to as the heartburn. The signs and symptoms include but are not limited to; Aburning sensation in your chest area,regurgitation of a sour liquid, difficulty swallowingand a chronic cough.If not treated this symptoms eventually evolve into long term diseasessuch as ulcers, aesophagitis and ultimately cancer(? ).in the food ingestion process food flows through the aesophagus , a thin muscle whichis circular opens up and allows food into the stomach. This muscle is known as thelower aesophageal sphincter. After entry the muscle closes again.If the muscle relaxesor collapses due to weakening it allows fluids to flow back into the aesophagus. It isimperative to note that this situation is abnormal and may be accelerated by conditionssuch as obesity, delayed stomach emptying, smoking, pregnancy among others. Since theaesophagus is not covered by a thick lining like the stomach, it is inflamed by the acids andhence causing an inflammatory like feeling on the inside of the chest. over time chronicinflammation results to an open sore on the aesophagus, narrowing of the aesophagusand precancerous changes to the aesophagus. over the years human beings resulted to avariety of ways of treating stomach acid{related woes, proven and otherwise,In the 70’s adrug called cimetidine was introduced , cimetidine worked by inhibiting the production ofgastritic juices by the stomach. cimetidine was quite a success but at the same time it hadits own fair share of side effects. famotidine (Pepcid) and ranitidine (Zantac) generallyknown as H2 blockers came after this and quickly gained track also. In recent years theH2 blockers hace evolved to the drugs we commonly know as the proton-pump inhibitordrugs (PPIs) PPIs include drugs like Prevacid (lansoprazole), Prilosec (omeprazole), andNexium (esomeprazole). This drugs are recommended mainly to prevent or treat ulcersin the deudenum and the stomach. And to the advantage of our study,They also counterthe condition called gastroesophageal reflux disease (GERD). In most head-to-head trials,the PPIs have outshined the H2 blockers. This study intends to analyze the efficiencyand efficacy in treating GERD through analyzing past researches and data collected byresearches on the same topic.1Figure 1: a representation of the Gastroesophageal Reflux Disease.2 Materials and MethodsThis paper will mainly focuss on past researches conducted on this topic, as such literaturematerials dating 2000 to date were used for this paper.The articles primarily focussed onthe comparison of the various Ppis based on two criterias, their safety and their healinglevels. Literature databases such as Google Scholar database came in handy to help outwith a comprehensive yet understandable analysis. Latex software was used to compilethe document and make it look less literature like and more scientific.23 Literature ReviewOver the years multiple or numerous studies have been conducted in a bid to explainand maesure the eficacy of proton inhibitors separately. The purpose of this study isto analyze all this studies, combine them and show which of the drugs is the most effective and efficient in treating GERD associated compications. Srikanth et al. (2014)conducted a case study involving patients who had been confirmed to have GERD anderosive esophagitis in the global hospital Utharahalli and Karnataka, In India in the years2013 to 2014. in this study two groups were chosen randomly, one was treated with Pantoprazole and the other with esomeprazole. the first group was given a 40mg dose ofpantoprazole, the dose was given twice daily before having food for 7 days.After the firstweek they were then given one dose daily for 8 weeks.The other group was given a daily40 mg dose of esomeprazole for 8 weeks.gerd symptoms were assessed on two visits , onthe fourth and eigth week.The Results showed that esomeprazole was more effective thanpantoprazole in healing heart burn effects durng week 4 (56.36% vs. 49.09 In anotherstudy 4 PPI drugs were compared by Zheng (2009). the drugs compared were; esomeprazole, lansoprazole,omeprazole and pantoprazole. In this study 274 patients proven to haveesophagitis were selected from the hospital of Hainan medical college, China. Each randomly selected patient was administered with a dose of a randomly selected drug of thefour drugs.The drugs were administered for 8 weeks day in day out in the morning.Eachdrug was administered with the following respective dosage Omeprazole 20mg, Pantoprazole 40mg, Lansoprazole 30mg, esomeprazole 40mg. Hpylori and reflux esophagitis weretested using the Elisa test.On a scale of 0 to 5 the patients would provide daily reportsof their severity, 0 being none and 5 being severe.The results from the study as provideby the researcher were as follows , in comparison to other drugs esomeprazole showed thehighest efficiency during the first two days. After 5 days healing of esophagitis showedhighest result with esomeprazole with 95.4% , followed by pantoprazole, lansoprazole,omeprazole at 91.1%, 89.6% , 87.7% respectively, Chen et al. (2005) also conducted astudy on the same, unlike the other studies this had lesser participants. Only 44 patientswere included in the study . 24 of the patients were given 40 milli grams of esomeprazole and the other 20 were given a 20 milligram dose of omeprazole. The study wasconducted in an 8 week intensive period with two follow ups on week 4 and 8. As expected the study did not deviate from the rest of the studies, esomeprazole showed theefficiency with 72.7% as compared to omeprazole 50%. Unlike other studies though, Chenet al conducted a safety test on the drugs,the results from the safety test showed that28% of the patients receiving osemoprazole had adverse effects as compared to 26% ofthose receiving omoprazole. The side effects included diarrhea, headaches,constipationand dry skin.Analysis of the results from this study showed that patients who receivedesomeprazole were healed faster than omeprazole but had more likely hood of getting theaforementioned side effects.A Multicenter clinical trial conducted by (Kahrilas et al., 2000) also showed the sameresults, esomprazole had a healing rate of 94% compared omeprazoles 89.1%. This studywould be the most accurate among the others as it involved a relatively larger numberof patients. 1960 patients from 140 medical centres in the united states. Due to the sideeffcets of the doses, 159 patients did not complete the survey. The rest were adminis-3Table 1: drug, healing percentageesomeprazole 91omeprazole 89planteprazole 85tered with random doses of,Esomeprazole 40mg. The side effects in this study includedheadache, abdominal pain, diarrhea , gastritis, flatulence, respiratory infection. Lind etal. (2000) had another approach to measuring the impacts of the two main PPIs . Shemeasured the acid levels in the stomach.The study was conducted on 36 patients , halfwere given a 40mg dose of esomeprazole and the rest a 40mg dose of omeprazole. TheResult showed that Esomeprazole at a dose of 20 mg and 20 mg maintained intra gastricpH 4foraperiodof16:8and12:7hrsrespectively;whereas omeprazole 20mg maintained pH4for10:5hrsHowever24hrsintragastricpHwashigherinesomeFrom the analysis of the five separate studies conducted different and on different populations , one thing is clear as day, Esomeprazole is more effective than the rest of thePPis in treating GERD related complications.4 Summary and ConclusionsThe main purpose of this secondary survey of past literature’s was to determine whichof the commonly used PPIs was more efficient in ameliorating the effects or the signsand symptoms of GERD. The studies show that esomeplazole leads in this battle, On allof the studies analyzed, esomeplazole had the highest level of efficiency averaging about91% healing capacity, it was followed by omeplazole , lansoplazole and plantoplazole inthat order.. However, other studies differ in comparing the healing rate with omeprazole,pantoprazole and lansoprazole Some studies show that pantoprazole and lansoprazoleare superior over omeprazole Zheng (2009) Whereas other previous studies show thatomeprazole is more effective than lansoprazole and pantoprazole (Jaspersen et al., 1998),In this regard it is safe to conclude that none of this studies contested the healing level ofesomeplazone. In terms of safety, there was no huge variance, All the four drugs showedalmost similar side effects with almost the same severity.References[1] . Bardhan, K., Van Rensburg, C., and investigators) (2001).[2] Chen, C.-Y., Lu, C.-L., Luo, J.-C., Chang, F.-Y., Lee, S.-D., and Lai, Y.-L. (2005).World Journal of Gastroenterology: WJG, 11(20):3112..[3] Gracie, D. J. and Ford, A. C. (2016). The Medical Journal of Australia,205(7):292{293.4[4] Khatri, M. (2019). Gerd: Symptoms, causes, treatments, remedies for relief.[5] WJG, 15(8):990. Comparative study of omeprazole, lansoprazole, pantoprazole andesomeprazole for symptom relief in patients with reflux esophagitis. World journal ofgastroenterology Zheng, R.-N. (2009).5

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