Effective intra-oesophageal acid suppression in patients with gastro-oesophageal reflux disease: lansoprazole vs. pantoprazole M. FRAZZONI*, E. DE MICHELI*, A. GRISENDI* & V. SAVARINO   *Divisione di Medicina Interna e Gastroenterologia, Ospedale S. Agostino, Modena, and  Dipartimento di Medicina Interna e Specialita ` Mediche, Universita ` di Genova, Genova, Italy Accepted for publication 2 October 2002 SUMMARY Background: Effective intra-oesophageal acid suppres- sion is an important therapeutic goal in complicated and atypical gastro-oesophageal reflux disease. Aim: To compare the efficacy of lansoprazole and pantoprazole in normalizing oesophageal acid exposure. Methods: Fifty patients with complicated or atypical gastro-oesophageal reflux disease were randomly assigned to receive 30 mg lansoprazole (n ¼ 26) or 40 mg pantoprazole (n ¼ 24) once daily. Three to four weeks after the start of treatment, patients underwent 24-h oesophageal pH monitoring whilst on therapy. If the results were improved but still abnormal, the dosage was doubled and pH monitoring was repeated. If oesophageal acid exposure was not improved, the patient was shifted to the alternative drug regimen. Results: Oesophageal acid exposure was normalized in all 26 patients treated with lansoprazole (in 35% of cases with a double daily dosage), whereas in six of the 24 (25%) patients treated with pantoprazole it was neither normalized nor lowered (P ¼ 0.008). Accord- ingly, the mean percentage acid reflux time was significantly lower for the lansoprazole group (2.1) than for the pantoprazole group (5.8) (P ¼ 0.032). Conclusions: Effective intra-oesophageal acid suppres- sion can be accomplished more reliably with lansopraz- ole than with pantoprazole in patients with complicated and atypical gastro-oesophageal reflux disease. INTRODUCTION Gastro-oesophageal reflux disease (GERD) encompasses a variety of symptoms, coupled with endoscopically visible mucosal lesions in less than one-half of cases, resulting from abnormal exposure of the oesophageal mucosa to refluxed gastric material. 1 It affects up to 20% of the adult Western population, 2 and is the main risk factor for the development of Barrett’s oesophagus 3 and oesophageal adenocarcinoma. 4 Acid suppression is the mainstay of the medical treatment of GERD. 1 Proton pump inhibitors provide rapid symptomatic relief and healing of oesophagitis in most patients; 5 they have been shown to be superior to H 2 -receptor antagonists, both in terms of the healing of erosions ⁄ ulcers and in relieving associated symptoms. 6 This is due to their greater suppression of 24-h intragas- tric acidity, as there is a significant correlation between the degree of acid suppression and oesophageal healing rates. 7, 8 Indeed, maintaining pH levels above 4.0 is considered to be the critical factor for the healing of severe ulcerative oesophagitis, 8 for reducing re-dilatation rates in patients with peptic oesophageal strictures 9 and for preventing the development of dysplasia and oeso- phageal adenocarcinoma in patients with Barrett’s oesophagus. 10 However, complete proton pump inhibitor-induced eradication of heartburn and acid regurgitation in patients with GERD complications does Correspondence to: Dr M. Frazzoni, Medicina Interna e Gastroenterologia, Ospedale S. Agostino, P.zza S. Agostino 228, 41100 Modena, Italy. E-mail: marziofrazzoni@hotmail.com Aliment Pharmacol Ther 2003; 17: 235–241. doi: 10.1046/j.1365-2036.2003.01405.x Ó 2003 Blackwell Publishing Ltd 235