The six remaining studies were a hodge-podge group of trials comparing various PPIs at different doses, none of which demonstrated any superiority. Andrea : All of the studies, except for the two that compared esomeprazole and omeprazole, found that there were no differences among any of the drugs in the treatment of GERD. As for the two studies that suggested esomeprazole was better than omeprazole, the studies were not fair comparisons.
Both studies used higher dosages of esomperazole compared with omeprazole. This cannot be considered a true comparison of effectiveness. In the study comparing esomeprazole with omeprazole, esomeprazole did better. Well, that's no surprise—esomeprazole is the active isomer of omeprazole, and the study authors used a dosage four times that of omeprazole. Breaking this down, they used 40 mg of active drug esomeprazole versus 10 mg of active drug omeprazole the dosage is actually 20 mg, but since omeprazole is a racemic mixture, that is only 10 mg of active drug , and guess what?
The drug not going off patent did better! And who sponsored the study? Astra-Zeneca, the manufacturer. Bob : I knew you would jump on the inappropriate comparison of esomeprazole with omeprazole. Another problem with this comparison is that a true clinical end point is not being measured. But I have the same complaints as I did with the GERD studies regarding the use of unequal dosages and using endoscopic cure rates as the end point.
And do I even have to do the H. Sixteen studies with no differences noted among any PPIs. Bob : Meta-analysis can be tricky.
A series of principles needs to be followed for the results to be valid. In this study, the authors appropriately identified a clear study question, performed a fairly comprehensive review of available databases although they did not include any abstracts from presentations at symposia or obtain unpublished clinical trials from the FDA or the drug companies , and used clear end points to determine cure or failure—so far, so good. The most obvious faux pas the authors made was not grading the quality of the studies they incorporated in this meta-analysis.
They did, however, redeem them-selves slightly by incorporating only randomized prospective trials. Mark : This faux pas is a problem. How do we know that the studies they included were any good? We don't. I like their conclusions and I am sure they are correct, but they need to grade the papers included in their analysis; other-wise, we have no assurance that they were any good. Bob : I feel comfortable saying there are no differences in efficacy among any PPIs for the above conditions.
It also has been suggested that PPIs are associated with increased rates of community-acquired pneumonia 1 and Clostridium difficile colitis. Andrea : There are no differences among PPIs except cost, so go with the cheapest.
However, the cheapest is not what ends up in our sample cabinet. Mark : I agree—save your patient some cash and go for the less expensive drug. The pH level falls well below the neutral level, giving it a pH level of less than 4, which can dissolve most edible food substances. Do take note that digestion mainly occurs in the small intestines and not in the stomach.
The stomach lining can take this much acidity and not damage the stomach cells. However, one needs to take care of the stomach, since too much acidity can eventually corrode the protective layers and damage the cells, leading to gastric ulcerations. At the initial stage, stomach cell irritation may occur, which is characterized by reddened spots visible under an endoscope.
During this time, the protective layers weaken which could lead to gastric acid to slowly corrode the area. For this, doctors often prescribed medications that prevent gastric contents from becoming too acidic.
These drugs are Nexium and AcipHex, and they have their own differences. The first medication is the Nexium, which is the brand name of Esomeprazole. It has been used for some time now and it has been proven to be effective in reducing discomfort from gastric acid increase in the stomach. Nexium is a proton-pump inhibitor, which prevents the formation of gastric juice by inhibiting enzymes that are responsible for gastric juice production.
Nexium relieves heartburns or stomach upsets, as well as preventing these from recurring. On the other hand, there is AcipHex, which is the brand name for Rabeprazole. It is another type of proton-pump inhibitors that have been tested for short-term relief from complaints of gastric upsets caused by acidity.
AcipHex has a faster effect than Nexium and patients can feel relief a little quicker. I then moved on to Omeprazole. These were far more effective in suppressing acid production, but again there was depression, and more significantly, a lot more joint pain which took a lot longer to pass away when I discontinued the Omeprazole. I tried this on a number of ocassions, and on each occasion the joint pain was more severe.
Finally I tried Rabeprozale, one 20mg tablet per day. I had asked my GP for the lower dose of 10mg, but was mistakenly prescribed the higher one.
I have been suffering from worsening arthritic pain in the joints ever since. One theory is that the suppression of acid in the gut puts the balance of the intestinal flora out of whack, and that some of the more insidious of these may then migrate to the joints if there is a leaky gut. Anyone else have this kind of a problem? Aciphex My gastroenterologist recently added this to my daily medications after I began having stomach pains during the night and after eating certain foods.
I thought they were gall bladder attacks but she believed it was acid reflux. After starting this medication I have had almost no episodes of this and it has helped reduce more IBS symptoms as well. Aciphex didn't stay effective for me. I started taking Aciphex over four years ago. At first it worked great. Gradually, the hearburn started creeping back and I started having trouble swallowing. They bumped me up to 20mg twice a day and that worked for a couple more years. My insurance recently removed this drug from the list of "approved" medications so it's cost effectiveness rating is way down.
I ended up with some complications from a respiratory infection and coughing which caused a large hiatal hernia and I no longer had any sphincter left. I went in for a Nissen fundoplication on November and had submitted a report on that procedure on this forum. I'm no longer on the Aciphex and seem to be on the mends. My thought is that if you can postpone a surgical repair, you should, and Aciphex may allow you to do that.
Aciphex causes insomnia? I have been taking Aciphex for about three weeks. However, I have been battling insomnia within the past couple of weeks, and wonder if Aciphex is the culprit. Insomnia is listed as a side effect. I lie awake, not fretting over anything, but I just can't sleep. Just as I am about to nod off, I will experience a slight twitch or jerk.
It's not restless legs syndrome, for the jerks are minor and occur all over my body. I'd rather suffer from GERD. Please email me if you have ever experienced similar symptoms.
Best one out there When I was on this I had no symptoms and it was wonderful, one pill each morning and I was able to eat within reason what I wanted. Caused depression I switched from Prevacid to Aciphex after insurance refused to cover Prevacid any longer. I have been having serious problems with depression and I think alot of it has been caused by the Aciphex since the deperession and suicidal thoughts have worsened since I have been on the Aciphex. Works Great!! Been on A for a week-no heartburn-no side effects!
Great drug! Aciphex rocks! I took 40mg a day, and never had a symptom. Of course, I had insurance, so I cannot comment on the cost effectiveness. Prevacid, the first one I was prescribed, produced intense bloating, nausuea, gas and diahrrea. I was then prescribed Prilosec and it offered some relief, but Aciphex worked better.
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