Mohammad Farivar, MD, FACP, FACG. Lecturer on Medicine, Harvard Medical School; Alexander S. Farivar, Surgery Dept, University of Washington, Seattle, Washington; Robert Saeid Farivar, MD, PhD. Dept of Surgery, Brigham & Woman Hospital, Harvard Medical School, Boston, MA.

Purpose: It is generally believed that iso-potent doses of PPIs are equally effective in relieving heartburn. This survey was done to test the efficacy of esomeprazole (Nexium) and pantoprazole (Protonix) to the traditional PPIs, lansoprazole (Prevacid) and omeprazole (Prilosec), in providing heartburn relief.

Methods: Over a three-month period 27 consecutive patients (16 females and 11 males, aged 25-80 years) with a history of frequent daily and nightly heartburn were included in this study. Index endoscopy had revealed erosive esophagitis in 13 patients prior to initiation of PPI treatment. All patients were asked to discontinue their regimen of lansoprazole (30 mg) or omeprazole (20-40 mg), and to take esomeprazole (40 mg), followed by pantoprazole (40 mg) (or vice versa) for one month. Patients were given a survey asking them to compare the effectiveness of their established regimen of omeprazole or lansoprazole to equivalent doses of pantoprazole and esomeprazole. All surveys were completed and returned. Daily Heartburn was graded from 1 (not often) to 5 (very often) during both day and night. Patient satisfaction with medication was graded from 1 (not satisfied) to 5 (very satisfied).

Results: Average heartburn score prior to PPI treatment was 4.61 during the day and 4.06 at night. All patients had been on varying doses of omeprazole and lansoprazole for years with significant (p<0.01) heartburn score improvement (1.37 during the day and 1.55 at night). On esomeprazole, heartburn score improved to 1.29 during the day and 1.33 at night. On pantoprazole, heartburn score increased significantly (p<0.01) to 3.48 during the day and 3.10 at night. Heartburn score changes with all PPIs represent statistically significant improvement comparing to no PPI treatment. Similarly, satisfaction scores were lowest at 2.06 with pantoprazole and highest at 4.44 with esomeprazole.

Conclusions: When comparing pantoprazole and esomeprazole to traditional PPIs, esomeprazole provided slightly better heartburn relief (not statistically significant), while pantoprazole was significantly worse. Further surveys will need to be performed as our experience with these newer PPIs increases.