S829 Efficacy of Esomeprazole for Healing and Maintenance of Erosive Esophagitis: A Meta-Analysis of Randomized Controlled Trials

Introduction: This meta-analysis evaluates the efficacy of esomeprazole in both induction and maintenance of healing in erosive esophagitis (EE) using data from randomized controlled trials. EE, a gastroesophageal reflux disease subtype, involves visible esophageal mucosal injury. While prior meta-analyses assessed proton pump inhibitors as a class, few focused exclusively on esomeprazole across both phases. This study consolidates esomeprazole-specific randomized controlled trial (RCT) data, providing a focused analysis across comparators, dosages, and treatment durations. Methods: This meta-analysis included 5 treatment-control comparisons from 3 RCTs evaluating esomeprazole (40 mg, 20 mg, 10 mg) for healing or maintenance of EE. Controls included omeprazole, pantoprazole, or placebo. Primary outcome was endoscopic healing at 4-8 weeks or maintenance at 6 months. Log risk ratios (lnRR) and variances were calculated. A DerSimonian-Laird random-effects model was used. Heterogeneity was assessed using Q, I², and τ². Funnel plots were used to assess publication bias. Results: The meta-analysis included 5 comparisons with 3,885 patients. Esomeprazole showed a pooled RR of 1.074 (95% CI 1.040-1.108; P < 0.0001) compared to controls, with each trial reporting higher healing or maintenance rates in the esomeprazole arm. Heterogeneity was high (Q = 152.13, df = 4; P < 0.0001; I² = 97.37%; τ² = 0.0205), likely due to differences in dosing, comparators (omeprazole, pantoprazole, placebo), and timing of outcome assessments. Funnel plot asymmetry suggested possible small-study effects, though interpretation is limited by the small number of studies. By consolidating RCTs focused solely on esomeprazole across both treatment phases, this analysis provides a clearer assessment of its efficacy, demonstrating a consistent and statistically significant benefit despite inter-study variability. Conclusion: This meta-analysis found that esomeprazole was associated with a statistically significant increase in healing and maintenance rates in erosive esophagitis across randomized controlled trials. Observed variability between studies warrants consideration in future comparative trials using standardized methodologies.