Control of 24-hour Intragastric Acidity With Morning Dosing of Immediate-release and Delayed-release Proton Pump Inhibitors in Patients With GERD

Goals: To compare the effects of immediate-release omeprazole and 2 different delayed-release proton pump inhibitors on 24-hour intragastric acidity in gastroesophageal reflux disease patients. Background: Because of its unique pharmacokinetic properties, immediate-release omeprazole does not need to be dosed before a meal to control intragastric acidity. Previous studies showed effectiveness of immediate-release omeprazole in controlling nocturnal intragastric acidity with bedtime closing. This is the first study to compare the effects of prebreakfast dosing of immediate-release omeprazole and delayed-release lansoprazole and pantoprazole on 24-hour intragastric acidity. Aim: To compare the effects of prebreakfast dosing of immediate-release omeprazole 40 mg capsules, lansoprazole 30 mg capsules, and pantoprazole 40 mg tablets oil 24-hour intragastric acidity. Methods: Fifty-five patients with gastroesophageal reflux disease received 7 consecutive once-daily morning doses of each drug in this open-label, randomized, 3-period Crossover Study. On day 7, intragastric pH was recorded for 24 hours. Results: After 7 days, the percentage of time with intragastric pH > 4 over 24 hours was 59.7% (14.3 hours) with immediate-release omeprazole, 48.8% (11.7 hours) with lansoprazole (P = 0.005), and 41.8% (10.0 hours) with pantoprazole (P < 0.001). Median intragastric pH was significantly higher with immediate-release omeprazole than with lansoprazole (P = 0.003) or pantoprazole (P < 0.001). All drugs were well tolerated. Conclusions: When closed in the morning, immediate-release omeprazole provided significantly better control of 24-hour intragastric acidity than lansoprazole and pantoprazole.