Esomeprazole (
Nexium); S-
omeprazole) is a single optical isomer
proton-pump inhibitor (PPI) approved for the management of reflux oesophagitis, the symptomatic treatment of
gastro-oesophageal reflux disease (GORD), the prevention and healing of
NSAID-associated
gastric ulcer disease (and the prevention of
NSAID-associated
duodenal ulcers in the UK), the treatment of Helicobacter pylori
infection and associated
duodenal ulcer disease (and prevention of relapse of H. pylori-associated
peptic ulcers in the UK), and the treatment of
Zollinger-Ellison syndrome (and other hypersecretory syndromes in the US).Once-daily oral
esomeprazole 40 mg demonstrates greater antisecretory activity than other PPIs. Overall, in well designed clinical studies of 4 weeks' to 6 months' duration in patients with GORD,
esomeprazole had similar or better efficacy than other agents. In patients requiring ongoing treatment with
NSAIDs, co-
therapy with once-daily
esomeprazole 20 or 40 mg achieved relief of gastrointestinal symptoms or prevented
ulcer occurrence, more effectively than placebo.
Esomeprazole was also better than
ranitidine 150 mg twice daily in healing
NSAID-associated
gastric ulcers. In addition, the
drug has demonstrated efficacy as part of a triple-
therapy regimen for the eradication of H. pylori
infection, the healing of H. pylori associated
duodenal ulcers and the prevention of relapse of
gastric ulcers.
Esomeprazole also effectively treated patients with
Zollinger-Ellison syndrome.
Esomeprazole is generally well tolerated with an adverse-event profile similar to that of other PPIs. Thus, the efficacy and tolerability of
esomeprazole for the management of GORD and H. pylori eradication remains undisputed, and the data support its use for the first-line treatment of
NSAID-associated
gastric ulcer disease and
Zollinger-Ellison syndrome.