83 ratings on Drugs.com. President and Medical Director, Oklahoma Foundation for Digestive Research, Oklahoma City, OK; Medical Department, Eisai Inc., Teaneck, NJ and Medical Department, PriCara, Unit of Ortho-McNeil, Inc., Raritan, NJ. Results: After 3 weeks, complete healing (ITT analysis) was documented in 58% of patients given rabeprazole and 61% in patients given omeprazole (N.S.). This study was conducted to evaluate the effectiveness of two FDA-approved proton pump inhibitors, pantoprazole and rabeprazole, to control gastric acidity during the nocturnal hours when a single oral dose was taken prior to breakfast in the morning. The .gov means its official. Rabeprazole or pantoprazole is given 12 hours prior to measurement of intragastric pH. Placement of the nasogastric (NG) tube was verified by auscultation of the epigastrum during air insufflation. The purpose of the study is to compare the pharmacodynamics (the way a drug works in the body) of rabeprazole and pantoprazole on intragastric acidity and esophageal acid exposure in gastroesophageal reflux disease (GERD) patients with nighttime heartburn. The drug information provided is intended for reference only and should not be used as a substitute for medical advice. In an attempt to compare acid output with intragastric pH to determine which may be a more meaningful clinical endpoint to assess PPI efficacy, we plotted AO against intragastric pH (Fig. Here, rabeprazole produced a greater median intragastric pH roughly over the first half of observation, while pantoprazole appeared to maintain a greater median intragastric pH over the last half. During endoscopy, six gastric biopsies were taken from both the antrum (three biopsies), and from the body (three biopsies). Lansoprazole was less effective in improving acid regurgitation and epigastric pain than omeprazole (P = 0.0001, P = 0.033, respectively), pantoprazole (P = 0.005, P = 0.028, respectively), and rabeprazole (P = 0.026, P = 0.0001, respectively) (Table (Table66). Fisher RS, Sher DJ, Donahue D, et al. Wolters Kluwer Health Aliment Pharmacol Ther . Pantoprazole has active ingredients of pantoprazole sodium. The study sponsor played no role in the collection, analysis and interpretation of the data. Miner P, Jr, Katz PO, Chen Y, Sostek M. Gastric acid control with esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole: a five-way crossover study. The ITT population was defined as all patients initially enrolled who had taken at least one dose of study medication. Another 5 patients failed to complete both treatment periods due to discomfort caused by the NG tube. Overall, rabeprazole maintained mean pH at every threshold measured for a greater percentage of time as compared to pantoprazole (Fig. CONCLUSION: In elderly patients, pantoprazole and rabeprazole were significantly more effective than omeprazole in healing esophagitis and than omeprazole or lansoprazole in improving symptoms. Gillessen A, Beil W, Modlin IM, Gatz G, Hole U. Oral rabeprazole also maintained an overall greater median pH on day 1 of dosing over the nocturnal hours as compared to pantoprazole (Fig. (3,4,5) However Rabeprazole has been shown in vitro to be more readily converted to its active form than omeprazole, pantoprazole or lansoprazole. If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date. RxList does not provide medical advice, diagnosis or treatment. ED is often a symptom of another health problem or health-related factor. Pantoflickova D, Dorta G, Ravic M, Jornod P, Blum AL. Conclusions: In GERD patients with nocturnal heartburn, RAB 20 mg was significantly more effective than PAN 40 mg, in% time with intragastric pH >4 during the nighttime hours, as well as the daytime and 24-h periods. You can discuss the study with your doctor, to ensure that all drug risks and benefits are fully discussed and understood. HHS Vulnerability Disclosure, Help Review article: diagnosis and management of night-time reflux. In total, 15 subjects completed the study. Family Medicine 32 years experience. Publication types Aciphex is also used to treat duodenal ulcers, and used in combination with antibiotics to treat <i>Helicobacter pylori (H. pylori)</i> bacterial infections in the stomach. Fordtran JS, Walsh JH. Problems with the interpretation of gastric pH measurement. Rabeprazole has active ingredients of rabeprazole sodium. We compare the side effects and drug effectiveness of Pantoprazole and Rabeprazole. An official website of the United States government. In this population of older patients, pantoprazole and rabeprazole were significantly more effective in healing esophagitis than omeprazole. Patients with a history of past or present endoscopic evidence of any significant esophageal pathology (ulcers, erosions) were excluded from study participation. Baseline demographic and clinical characteristics are listed in Table 1. Official journal of the American College of Gastroenterology | ACG101:S73-S74, September 2006. Protonix Oral Suspension should not be taken in or with water or other liquids, or with other foods. 78% of reviewers reported a positive effect, while 14% reported a negative effect. Statistical analysis was performed using the 2 test (comparison of outcomes with the treatments) and Fisher exact test (healing rates related to H pylori infection, symptoms). A meta-analysis of 38 studies evaluating acute therapy of esophagitis reported that the PPIs were superior to ranitidine and placebo in healing erosive esophagitis, without significant differences in efficacy between omeprazole 20 mg daily and lansoprazole 30 mg daily, or pantoprazole 40 mg daily, or rabeprazole 20 mg daily[16]. The large p-value provides sufficiently strong evidence that the two treatments cannot be declared to have different effects in raising the pH of acid output when observed over the entire 12-hour period. The mean number of evaluable hours from the baseline examination, rabeprazole treatment group and pantoprazole treatment group was 10 h 45 m, 10 h 30 m, and 10 h 45 m, respectively. On day 1, oral rabeprazole inhibited acid output to a greater extent and for a longer period than pantoprazole, and the intragastric pH was significantly higher for rabeprazole than for pantoprazole over the first 8.3 hours. Bethesda, MD 20894, Web Policies Pratha VS, Hogan DL, Lane JR, et al. Review article: relationship between the metabolism and efficacy of proton pump inhibitors--focus on rabeprazole. It is important to go over these with your healthcare provider to . Pantoprazole has an average rating of No significant differences were found in the prevalence of adverse events among the four treatment groups. Copyright 2023 by RxList Inc. An Internet Brands company. The patient was questioned about the principal symptoms, i.e. diarrhea. Articles in Google Scholar by P. Miner, MD, Other articles in this journal by P. Miner, MD, Privacy Policy (Updated December 15, 2022). PPIs are a group of medications that work by lowering the amount of acid released in your stomach. A trend line imposed on the data indicates that rabeprazole maintains a significantly greater intragastric pH over the first 8.33 hours as compared to pantoprazole (p<.04). Conversely, the prevalence of other non-specific symptoms, i.e. Investigators remained blinded to treatment sequence until all patients had completed the study. More recently, a meta-analysis of eleven studies with 23 treatment arms reported no significant difference in the two-month healing rates of esophagitis between omeprazole 20 mg daily (n = 3.137 patients, pooled healing rate = 84.5%) and other PPIs, including lansoprazole, pantoprazole, rabeprazole, and esomeprazole at standard doses (n = 3.397 patients, pooled healing rate = 89.4%)[18]. Zimmerman J, Shohat V, Tsvang E, Arnon R, Safadi R, Wengrower D. Esophagitis is a major cause of upper gastrointestinal hemorrhage in the elderly. official website and that any information you provide is encrypted Before Meta-analysis of randomized controlled trials comparing standard clinical doses of omeprazole and lansoprazole in erosive oesophagitis. Note at pH>6, overlap is seen between the rabeprazole and pantoprazole curves. In Fig. Using the same location of points as selected for the pantoprazole less rabeprazole differences over the entire time period, the difference in pH levels between the baseline and rabeprazole treatment is statistically significant, while the pH differences between pantoprazole and the baseline were not (p>0.10). Further studies in assessing PPI efficacy should assess intragastric pH, acid output, and employ a validated questionnaire to evaluate symptomatic improvement of nocturnal complaints. The drug comparisons information provided does not cover every potential use, warning, drug interaction, side effect, or adverse or allergic reaction. The site is secure. pain in the abdomen (stomach area) sore throat. Nineteen patients (5.9% of the total population) dropped-out from the study due to: adverse events (2 patients), low compliance (11 patients), and refusal of endoscopy after two months of treatment (6 patients). At study entry, an endoscopy was performed to diagnose acute esophagitis (inclusion criteria). omeprazole, lansoprazole, pantoprazole, and rabeprazole, were 86.9%, 82.4%, 100%, and 100% for heartburn, 100%, 75.0%, 92.9%, and 90.1% for acid regurgitation, and 95.0%, 82.6%, 95.2, and 100% for epigastric pain, respectively (Table (Table6).6). Very recently, a systematic review of randomized controlled trials in patients with reflux esophagitis reported that esomeprazole demonstrated higher short-term healing rates when compared with standard dose PPIs[21]. Symptoms of ED include. You may be trying to access this site from a secured browser on the server. Rabeprazole or pantoprazole is given 12 hours prior to measurement of intragastric pH. The correlation coefficient (r-squared) of .3163 indicates that 31.63% of the variation in pH levels can be explained by the acid output. Three meals, considered typical, standardized Western meals in terms of fat (108 gram), carbohydrate (319 gram) and protein (97 gram) composition were provided at 0800, 1200 and 1730. 2. The purpose of the study was to compare the efficacy of oral rabeprazole 20 mg against oral pantoprazole 40mg on nocturnal acid production on day 1 of therapy when given one hour prior to a standard Western meal. Furthermore, the mean time-matched pH values differed significantly over the first 8.3 hours (p<0.05). Hourly acid output was derived by extrapolating the 30 minute acid output value. The mean difference in pH between pantoprazole and rabeprazole over the entire time-period was -0.3248. One distinct difference noted at 03:30 (8.5 hours into the study), when mean acid output is minimally greater under rabeprazole, most likely represents an anomalous value as subsequent measurements then demonstrate decreased acid output under rabeprazole. more Prescription only Pantoprazole is a proton pump inhibitor that decreases acid secretion in the stomach and may be given to relieve the symptoms of heartburn or to allow inflamed tissue in the gastrointestinal tract to If you notice symptoms like watery diarrhea, fever, or stomach pain that doesn't go away, talk to your healthcare provider right away. Klotz U. Previously, it has been shown that acid output in normal subjects peaks approximately 1.5 hours after a meal and gradually decreases over the next 2.5 hours so that at 4 hours post meal, acid output remains at 1/4 peak AO production.18 In the current study, rabeprazole suppressed acid output to a greater degree than pantoprazole over the entire observation period, including the post-meal hours (Fig. Maekawa T, Kinoshita Y, Okada A, Fukui H, Waki S, Hassan S, Matsushima Y, Kawanami C, Kishi K, Chiba T. Relationship between severity and symptoms of reflux oesophagitis in elderly patients in Japan. Rabeprazole, which has the highest pKa of all PPIs and is therefore least stable at neutral pH, is more rapidly converted to inhibit the proton pump as compared to omeprazole, lansoprazole or pantoprazole.14 This may be critical given the known short half lives of PPIs that limit time available to accumulate in the parietal canaliculus, to form the activated sulphenamide form, and to bind to inactivate proton pumps.15 In addition, rabeprazole may have more prolonged and potent acid inhibitory effects due to continued binding to proton pump transmembrane domains even after achieving 100% inhibition of ATPase activity.10, While the majority of available parietal cells typically maintain an intracellular pH near 1, a proportion of these target cells may have a pH as high as 3 depending largely on the age of that cell.11 In extremely acidic environments, proton pump inhibitors may have similar equipotency.11 However, in less acidic environments, rabeprazole, given its rapid activation over a wide pH range, actually targets a greater population of parietal cells to give a more rapid and pronounced degree of acid inhibition.16 In older parietal cells, rabeprazole can be as much as 10 times more potent that other proton pump inhibitors.11 In addition, rabeprazole has an advantage not shared by other proton pump inhibitors. 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