Esomeprazole 10mg gastro-resistant granules sachets

Background and objectiveErosive esophagitis (EE) is the second most common phenotype of gastroesophageal reflux disease (GERD). While proton pump inhibitors (PPIs) are considered the mainstay treatment for healing and maintaining remission of EE, a significant proportion of patients, particularly those with advanced grades, fail to respond adequately. This review provides an updated overview of the current pharmacological treatment options for EE.MethodsAn extensive electronic literature search was performed using PubMed database to identify relevant articles. The search included prospective clinical trials, observational trials, case-control studies, systematic reviews with or without meta-analysis, and narrative reviews describing pharmacological therapy for adult patients with EE. Articles were limited to English language publications. Search terms encompassed various treatment modalities including PPIs, potassium-competitive acid blockers (P-CABs), histamine 2 receptor antagonists (H2RAs), sucralfate, prokinetics, rebamipide and alginates.Key content and findingsResearch has shown varying effectiveness across different treatments for EE. While randomized controlled trials found alginates, sucralfate, and histamine-2 receptor antagonists to have limited healing efficacy, PPIs remain the most effective treatment, achieving healing rates of 75-95% after 8 weeks, though symptom resolution reaches about 60-85%. Among PPIs, esomeprazole shows slightly better healing outcomes compared to others. However, PPI effectiveness decreases in advanced EE cases [Los Angeles (LA) grades C/D], with healing rates dropping to 60-70%. More recently, P-CABs have demonstrated promising results, demonstrating healing rates non-inferior to PPIS but superior in patients with advanced EE or PPI-resistent EE. Given that most patients experience relapse upon discontinuation, maintaining PPI or PCAB therapy is crucial for preventing EE recurrence.ConclusionsThe future of EE management lies in a more personalized approach that takes into account disease severity, PPI response, and patient preferences. While PPIs remain the mainstay of treatment, P-CABs represent a promising new therapeutic option, particularly for severe and PPI-resistant cases. The addition of nighttime to bedtime H2RAs or use of double PPI dose may benefit refractory cases. Further studies are needed to directly compare PPIs and P-CABs in different EE grades and evaluate the value of adjunctive therapies.

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Randomized controlled trials (RCTs) suggest that potassium-competitive acid blockers (PCABs) are non-inferior to standard-dose proton pump inhibitors (PPIs) for erosive esophagitis (EE). However, direct comparative data against double-dose or dual-delayed release PPIs remain limited. This network meta-analysis (NMA) ranks the efficacy of PCABs and PPIs (standard, double, and dual-delayed-release doses) for EE healing and maintenance. A systematic search of MEDLINE, EMBASE, and the Cochrane Library from inception through February 2, 2025 (updated on December 15, 2025) identified RCTs comparing PCABs or PPIs in adults with endoscopically confirmed EE or previously healed EE. Primary outcomes were EE healing at weeks 4 and 8, and maintenance at 6 months. A frequentist NMA estimated risk ratios (RRs) with 95% confidence intervals (95%CI), using vonoprazan 20 mg once daily (QD) and 10 mg QD as reference for healing and maintenance studies, respectively; ranking metrics (P-scores) were used descriptively. A total of 99 RCTs were included. At week 4, several regimens showed similar healing rate to vonoprazan 20 mg QD, including linaprazan 75 mg BID, linaprazan 50 mg BID, and zastaprazan 20 mg QD. At week 8, zastaprazan 20 mg QD was significantly better than vonoprazan 20 mg QD (RR 1.10; 95%CI 1.01-1.21; P-score = 0.92). For maintenance at 6 months, several standard-dose regimens (including esomeprazole 40 mg QD and vonoprazan 20 mg QD) showed similar efficacy, whereas lower-dose PPIs performed worse. Adverse events were comparable across therapies. Zastaprazan 20 mg QD and esomeprazole 40 mg QD demonstrated the highest efficacy for EE healing and maintenance, respectively. Overall, PCABs did not consistently outperform dual-delayed release or double-dose PPIs.

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Gastroesophageal reflux disease (GERD) is a chronic relapsing disorder often inadequately controlled with proton pump inhibitors (PPIs), particularly in patients with nocturnal acid breakthrough (NAB) or non-erosive reflux disease (NERD). Tegoprazan, a potassium-competitive acid blocker (PCAB), offers rapid, potent, and CYP2C19-independent acid suppression. This systematic review and meta-analysis evaluated randomized controlled trials comparing Tegoprazan with PPIs in adults with GERD and related disorders. Databases searched included PubMed, Cochrane, Wiley, and ClinicalTrials.gov (2015-2026). Eighteen studies met inclusion criteria. In erosive esophagitis, Tegoprazan 50 mg once daily achieved mucosal healing rates of 91.1%-99.1%, non-inferior to PPIs (93.5%-98.9%; pooled RR = 1.01, 95% CI 0.98-1.05). Pharmacodynamic and clinical studies demonstrated faster acid suppression and improved nocturnal pH control versus PPIs, achieving pH ≥ 4 within 30-60 min and maintaining levels throughout the 12-h period. In nocturnal symptom analyses, Tegoprazan achieved earlier relief (1.5 vs. 3 days to first heartburn-free night) and higher proportions of heartburn-free nights (57.8% vs. 43.1%), with significantly greater complete (p = 0.038) and partial (p = 0.034) nighttime symptom resolution than Esomeprazole. In NERD, symptom resolution ranged from 42.5% to 48.9% versus 24.2% with placebo. In open-label functional dyspepsia cohorts, improvements ranged from 74.6% to 86.7% in open-label cohorts. Seven trials (n = 2492) showed higher Helicobacter pylori eradication with Tegoprazan-based therapy (RR = 1.05, 95% CI 1.01-1.09; p = 0.006; I 2 = 0%). Adverse events were mild and comparable to PPIs. Tegoprazan provides rapid, sustained acid suppression, effective nocturnal symptom control, and a modest but statistically significant improvement in H. pylori eradication, representing a potential alternative to PPIs for patients with persistent or CYP2C19-related variable response.

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Background: This investigation compared the efficacy and safety of fexuprazan 40 mg and esomeprazole 40 mg in patients with acid reflux-related disorders, including erosive esophagitis (EE) and laryngopharyngeal reflux disease (LPRD). Methods: A systematic search was conducted across five databases until January 2025. Primary outcomes included esophageal lesion healing, complete resolution of symptoms (CRS), and 24 h symptom-free days. Meta-analyses used random-effects models with the inverse variance method. The Risk of Bias 2.0 tool and the certainty of evidence (CoE) using GRADE methodology were assessed. Results: Three randomized controlled trials (n = 695) conducted in Asian countries were included. Fexuprazan may have little to no effect compared to esomeprazole on EE healing rate at 4 weeks (RR 1.02, 95% CI 0.93 to 1.12, I2 = 0%, n = 2 studies, CoE very low) and 8 weeks. No significant differences were found between treatments regarding CRS at 1 week (RR 1.29; 95% CI: 0.84 to 1.99; I2 = 0%; n = 2 studies; CoE very low) and 8 weeks, or in the 24 h symptom-free days at 1 week (MD 2.67 days, 95% CI -2.76 to 8.10, I2 = 41%, n = 2 studies, CoE very low) and 8 weeks. Fexuprazan also showed little to no effect on treatment-emergent adverse events (RR 1.00, 95% CI 0.83 to 1.20, I2 = 0%, n = 3 studies, CoE very low). Nonetheless, the evidence for all outcomes was rated as very uncertain. Conclusions: Fexuprazan 40 mg may provide similar efficacy compared to esomeprazole 40 mg in EE, with a comparable safety profile to esomeprazole in EE and LPRD patients. However, the evidence is highly uncertain, requiring further studies.

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BackgroundErosive esophagitis (EE) is commonly managed with proton pump inhibitors (PPIs), yet many patients experience incomplete healing or recurrence. Potassium-competitive acid blockers (P-CABs) have emerged as potential alternatives, but high-certainty comparative evidence across agents remains limited. We performed a network meta-analysis to evaluate the relative efficacy and safety of P-CABs versus PPIs and to assess the certainty of the evidence.MethodsWe systematically searched PubMed, the Cochrane Library, and Web of Science from inception through March 1, 2025, for randomized controlled trials (RCTs) comparing P-CAB, PPI, and/or placebo for the treatment of EE. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Key outcomes were 8-week endoscopic healing and 24-week recurrence. Certainty of evidence was evaluated using GRADE. Risk difference (RD) estimates were calculated using random-effects models. The study protocol was registered with PROSPERO (CRD420251116179).FindingsThirty-nine RCTs were included; all evaluated once-daily dosing. At 8 weeks, zastaprazan 20 mg, vonoprazan 20 mg, and esomeprazole 40 mg demonstrated moderate-certainty superiority over rabeprazole 20 mg and omeprazole 20 mg with RDs ranging from 0.05 to 0.11, while only vonoprazan 20 mg demonstrated moderate-certainty benefit versus lansoprazole 30 mg (RD: 0.04). In Los Angeles (LA) grade C/D EE, vonoprazan 20 mg, esomeprazole 40 mg, and rabeprazole-ER 50 mg demonstrated moderate-to-high-certainty benefit over lansoprazole 30 mg and omeprazole 20 mg with RDs ranging from 0.05 to 0.15. Vonoprazan 20 mg and rabeprazole-ER 50 mg demonstrated moderate-certainty benefit compared with pantoprazole 40 mg (RDs: 0.12 and 0.09, respectively).At 24 weeks, vonoprazan 10 mg and 20 mg showed moderate-to-high-certainty benefit versus lansoprazole 15 mg (RDs: -0.11 and -0.13, respectively), while in direct comparisons, esomeprazole 20 mg outperformed lansoprazole 15 mg and pantoprazole 20 mg, with approximately 40-50% relative reductions in recurrence. In LA grade C/D EE, vonoprazan 10 mg and 20 mg demonstrated moderate-to-high-certainty superiority over lansoprazole 15 mg and pantoprazole 20 mg with RDs ranging from -0.12 to -0.20. Esomeprazole 20 mg showed a high-certainty benefit compared with pantoprazole 20 mg (RD: -0.16). At 8 and 24 weeks, safety profiles were generally comparable between P-CABs and PPIs.InterpretationAmong once-daily regimens, vonoprazan 20 mg, zastaprazan 20 mg, and esomeprazole 40 mg were most effective for healing EE, while vonoprazan 10 mg and 20 mg and esomeprazole 20 mg were most effective in preventing recurrence. Benefits were most pronounced in LA grade C/D EE and are supported by moderate to high-certainty evidence. Comparative trials evaluating newer P-CABs against optimized PPI strategies, including twice-daily dosing, are needed to evaluate efficacy and long-term safety, particularly with respect to hypergastrinemia and infection risk.FundingNone was received for the study.

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