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Esomeprazole: a new proton-pump inhibitor for NSAID-associated peptic ulcers and dyspepsia

Grace Lai-Hung Wong and Joseph JY Sung

Ulcer and ulcer symptoms related to the use of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin constitute a major global health issue. Despite various attempts to prevent and heal injuries inflicted by NSAIDs and aspirin, acid suppression remains one of the cornerstones in the management of NSAID-associated ulcers. Esomeprazole, the S-optical isomer (enantiomer) of omeprazole, suppresses gastric acid secretion by inhibiting the parietal cell membrane enzyme H⁺/K⁺-ATPase. With improved bioavailability, due to reduced first-pass metabolism in the liver, esomeprazole promises to be more potent in acid suppression in the stomach. Similar to omeprazole, the safety profile of esomeprazole has been well established. Clinical studies comparing esomeprazole with other proton pump inhibitors (PPIs) in the healing of NSAID-related ulcer are few. Recent multicenter randomized studies demonstrated that esomeprazole significantly improves dyspeptic symptoms in patients taking nonselective NSAIDs and specific cyclooxygenase-2 inhibitors. Esomeprazole also protects the stomach from aspirin-induced ulcer bleeding. Safety profiles of esomeprazole appear promising.