Control of gastric acid secretion by antisecretory agents has been the cornerstone of
therapy in the successful management of all
acid-related disorders, including
gastro-oesophageal reflux disease (
GERD), and duodenal and
gastric ulcer. Treatment efficacy has been strongly correlated with degree and duration of
acid suppression within the 24-h period and with total
duration of therapy. All
proton pump inhibitors are highly effective for the healing of
ulcers and erosive oesophagitis. All have closely similar mechanisms of action, yet important pharmacological differences exist, which can significantly impact certain aspects of their clinical efficacy.
Rabeprazole's rapid activation over a wide pH range may be the explanation for its early onset of effective
acid inhibition compared with other
proton pump inhibitors such as
omeprazole,
lansoprazole and
pantoprazole. Like
rabeprazole,
esomeprazole is also a potent inhibitor of gastric acid at steady state, although it is thought that
rabeprazole may provide enhanced first-day
acid suppression compared with
esomeprazole. First-day antisecretory efficacy should produce faster symptom relief, a hypothesis supported by clinical data. Moreover, drugs with pharmacological profiles that include both rapid onset and potent antisecretory effects should help control healthcare costs by reducing the need for otherwise commonly used twice-daily
proton pump inhibitor administration.