Intravenous esomeprazole versus pantoprazole for heartburn

A randomized controlled double-blind trial
  • O. KarakayaliEmail author
  • S. Yilmaz
  • A. Karakayali
  • Yavuz Yigit
  • Huseyin Cahit Halhalli
  • Tolga Uslu



Heartburn is one of the most common symptoms of gastrointestinal diseases. Intravenous (IV) administration of pantoprazole, lansoprazole, and esomeprazole is recommended by the US Food and Drug Administration (FDA) for short-term acute treatment. Although there are many studies on these drugs in the literature, they are frequently related to long-term oral use and changes in intragastric pH.


This study compared the effects of IV esomeprazole with those of IV pantoprazole in patients presenting to the emergency department with heartburn.

Materials and methods

For this randomized controlled double-blind trial, patients aged over 18 years presenting with gastritis-related heartburn were eligible. Study patients received 40 mg esomeprazole or pantoprazole in 100 ml normal saline. Pain intensity was measured on a visual analog scale (VAS) at 30, 60, and 120 min. Patients were randomized and assigned to either of the two study arms via closed envelopes.


Finally, 205 patients were randomized (esomeprazole: 104; pantoprazole 101). Mean age was 39.1 ± 13.78 years and 48.8% were male. Both esomeprazole (median VAS: 26 mm, interquartile range [IQR]: 17–38 mm) and pantoprazole (median: 24 mm, IQR: 14.5–36 mm) effectively reduced heartburn at 30 min, 60 min (median: 59.5 mm, IQR: 48–73.5 mm vs. 55 mm, IQR: 33–68.5 mm), and 120 min (median: 80 mm, IQR: 66.5–89.8 mm vs. 77 mm, IQR: 56–85 mm). While there was no statistically significant difference between the two drugs at 30 min (p = 0.312), there was a statistically significant difference in pain intensity between the esomeprazole and pantoprazole groups at 60 and 120 min (p = 0.014, p = 0.02, respectively).


Single-dose slow IV infusion of esomeprazole is faster and more effective in controlling heartburn than pantoprazole.


Pain Gastritis Visual analog scale Gastroesophageal reflux Emergency medicine 

Intravenöses Esomeprazol vs. Pantoprazol bei Sodbrennen

Eine randomisierte, kontrollierte, doppelblinde Studie



Sodbrennen ist eines der häufigsten Symptome gastrointestinaler Erkrankungen. Die intravenöse (i.v.) Applikation von Pantoprazol, Lansoprazol und Esomeprazol wird von der Food and Drug Administration (FDA) für die kurzfristige Akuttherapie empfohlen. Zwar sind viele Studien zu diesen Wirkstoffen publiziert, sie beziehen sich aber häufig auf eine dauerhafte orale Gabe und Veränderungen des intragastralen pH.


In der vorliegenden Studie wurden die Wirkungen von Esomeprazol i.v. mit denen von Pantoprazol i.v. bei Patienten verglichen, die mit Sodbrennen in der Notaufnahme vorstellig wurden.

Material und Methoden

In diese randomisierte, kontrollierte, doppelblinde Studie wurden Patienten über 18 Jahre mit gastritisassoziiertem Sodbrennen eingeschlossen. Die Patienten erhielten 40 mg Esomeprazol oder Pantoprazol in 100 ml Kochsalzlösung. Die Schmerzintensität wurde nach 30, 60 und 120 min mit einer visuellen Analogskala (VAS) gemessen. Die Patienten wurden mit der Closed-envelope-Methode randomisiert und einem der beiden Studienarme zugeordnet.


Insgesamt 205 Patienten wurden randomisiert (Esomeprazol 104; Pantoprazol 101 Patienten). Das Durchschnittsalter betrug 39,1 ± 13,78 Jahre, 48,8 % waren männlich. Sowohl Esomeprazol (Median: 26 mm, Interquartilbereich [IQR]: 17–38 mm) als auch Pantoprazol (Median: 24 mm, IQR: 14,5–36 mm) verringerten das Sodbrennen wirksam nach 30 min, 60 min (Median: 59,5 mm, IQR: 48–73,5 mm vs. 55 mm, IQR: 33–68,5 mm) und 120 min (Median: 80 mm, IQR: 66,5-89,8 mm vs. 77 mm, IQR: 56–85 mm). Während nach 30 min kein statistisch signifikanter Unterschied zwischen den beiden Gruppen bestand (p = 0,312), fand sich ein solcher in der Schmerzintensität nach 60 und 120 min zwischen der Esomeprazol- und Pantoprazolgruppe (p = 0,014 bzw. p = 0,02).


Die einmalige langsame i.v.-Infusion von Esomeprazol lindert Sodbrennen schneller und stärker als die von Pantoprazol.


Schmerz Gastritis Visuelle Analogskala Gastroösophagealer Reflux Notfallmedizin 



The authors would like to thank the physicians and healthcare professionals in the Emergency Department of Derince Training and Research Hospital for their contributions to this study.

Compliance with ethical guidelines

Conflict of interest

O. Karakayali, S. Yilmaz, A. Karakayali, Y. Yigit, H.C. Halhalli, and T. Uslu declare that they have no competing interests.

The rules of the Helsinki Declaration and current good clinical practice guidelines were followed. All patients were informed about this research, and written informed consent was obtained from all patients.


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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • O. Karakayali
    • 1
    Email author
  • S. Yilmaz
    • 2
  • A. Karakayali
    • 3
  • Yavuz Yigit
    • 1
  • Huseyin Cahit Halhalli
    • 1
  • Tolga Uslu
    • 1
  1. 1.Derince Training and Research Hospital, Emergency Medicine DepartmentHuman Health UniversityKocaeliTurkey
  2. 2.Emergency Medicine DepartmentKocaeli Faculty Of Medicine UniversityKocaeliTurkey
  3. 3.Derince Training and Research Hospital, Internal Medicine DepartmentHuman Health UniversityKocaeliTurkey

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