Rabeprazole may be the preferred high-dose PPI in severe eGERD

An interim analysis of a real-world study showed that the proton pump inhibitor (PPI) rabeprazole was associated with better outcomes than other PPIs, such as omeprazole/esomeprazole and pantoprazole, in patients with severe erosive gastroesophageal reflux disease (eGERD).

A prospective, real-world observational study from India compared the effectiveness of high-dose PPIs, rabeprazole (40 mg; n=130), pantoprazole (80 mg; n=65), and omeprazole (40 mg)/esomeprazole (80 mg; n=65), in patients with severe eGERD (n=260). Dr Kranthi Pebbili (Dr Reddy’s Laboratories, India) examined the outcomes after 4 weeks of therapy, followed by a 1-week follow-up [1].

Complete symptom resolution: Diurnal regurgitation resolved in 17.97% of patients on rabeprazole, compared with 5.08% on omeprazole/esomeprazole (P=0.018) and 8.20% on pantoprazole (P=0.077). For the complete resolution of nocturnal regurgitation, the corresponding rates were 14.06%, 1.59% (P=0.007), and 7.94% (P=0.22), respectively. In the subgroup of patients with work-related stress (n=132), rabeprazole also appeared to perform better than the other agents. Finally, among patients aged ≥60 years (n=62), the diurnal regurgitation resolution rate was 36.67% for those on rabeprazole and 0% for those on pantoprazole (P=0.003).

In conclusion, rabeprazole was associated with superior clinical outcomes compared with other high-dose PPIs in this interim analysis of patients with severe eGERD. These findings suggest that rabeprazole may be the preferred PPI in this setting, pending confirmation from the final analysis.

1. Pebbili KK, et al. Management of severe erosive gastroesophageal reflux disease (eGERD) with high-dose proton pump inhibitors: interim results from a real-world observational study (power 3.0). LB18, Latest news: From top to bottom, UEG Week, 4-7 October 2025, Berlin, Germany.

Medical writing support was provided by Robert van den Heuvel.
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Posted on 9 October 2025