Document Detail

Randomised clinical trial: twice daily esomeprazole 40 mg vs. pantoprazole 40 mg in Barrett's oesophagus for 1 year.
MedLine Citation:
PMID:  21385192     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Barrett's oesophagus is regarded as the most important risk factor for development of oesophageal adenocarcinoma. According to current guidelines, treatment should be limited to symptomatic Barrett's oesophagus.
AIM: To evaluate the expression of Ki67, cyclooxygenase-2 (COX-2) and apoptosis in Barrett's oesophagus after 12 months of double-dose proton pump inhibitor therapy. The effectiveness of esomeprazole and pantoprazole was also compared.
METHODS: Seventy-seven nondysplastic Barrett's oesophagus patients underwent baseline upper endoscopy. Patients were then randomised into two groups: one group was allocated to receive esomeprazole 40 mg b.d. and the other group pantoprazole 40 mg b.d. for 12 months. A follow-up endoscopy was performed at the end of treatment. Sixty-five of 77 patients agreed to undergo oesophageal manometry and 24-h pH-metry. Barrett's oesophagus biopsies, obtained at baseline and after treatment, were analysed using immunohistochemistry to assess Ki67 and COX-2 expression; apoptosis was evaluated using TUNEL.
RESULTS: In the esomeprazole group, a significant decrease in Ki67 and COX-2 expression, as well as an increase in apoptosis, were observed (P < 0.05). By contrast, in the pantoprazole group Ki67, COX-2 and apoptosis did not vary significantly from baseline. By 24-h oesophageal pH-monitoring, a normal acid exposure time was recorded in patients treated with esomeprazole, while those allocated to pantoprazole displayed abnormal acid exposure (P < 0.05).
CONCLUSIONS: Treatment of Barrett's oesophagus patients with high-dose esomeprazole, but not pantoprazole, promoted a decrease in proliferative markers, concomitantly with a decrease in apoptotic cell death. Moreover, esomeprazole allowed a better oesophageal acid control than pantoprazole.
N de Bortoli; I Martinucci; P Piaggi; S Maltinti; G Bianchi; E Ciancia; D Gambaccini; F Lenzi; F Costa; G Leonardi; A Ricchiuti; M G Mumolo; M Bellini; C Blandizzi; S Marchi
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2011-03-08
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  33     ISSN:  1365-2036     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-01     Completed Date:  2011-08-15     Revised Date:  2013-06-04    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  1019-27     Citation Subset:  IM    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
Gastroenterology Unit, Department of Internal Medicine, University of Pisa, Italy.
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MeSH Terms
2-Pyridinylmethylsulfinylbenzimidazoles / administration & dosage*
Aged, 80 and over
Anti-Ulcer Agents / administration & dosage*
Apoptosis / drug effects
Barrett Esophagus / drug therapy*
Cell Proliferation / drug effects
Cyclooxygenase 2 Inhibitors / metabolism
Esomeprazole Sodium / administration & dosage*
Esophageal pH Monitoring
Ki-67 Antigen / metabolism
Middle Aged
Proton Pump Inhibitors / administration & dosage
Treatment Outcome
Young Adult
Reg. No./Substance:
0/2-Pyridinylmethylsulfinylbenzimidazoles; 0/Anti-Ulcer Agents; 0/Cyclooxygenase 2 Inhibitors; 0/Ki-67 Antigen; 0/Proton Pump Inhibitors; D8TST4O562/pantoprazole; L2C9GWQ43H/Esomeprazole Sodium

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