Does BMI affect the clinical efficacy of proton pump inhibitor therapy in GERD? The case for rabeprazole

Background Increased BMI is associated with a higher risk of gastroesophageal reflux disease. Aims To investigate whether overweight/obesity (BMI >= 25 kg/m(2)) affects rabeprazole clinical efficacy versus omeprazole in patients with erosive esophagitis (EE). Patients and methods Post-hoc analysis of EE healing rate and symptom response stratified by patient BMI was performed on data from a multicenter, double-blind, randomized, 4-to-8-week trial comparing EE healing with rabeprazole (20mg daily) and omeprazole (20mg daily). Analysis of variance, two-sample t-test, Blackwelder's test for equivalence, log-rank, and Cochran-Mantel-Haenszel tests were used to analyze comparisons. Results In the two BMI groups (< 25 kg/m(2) and >= 25 kg/m(2) respectively), rabeprazole and omeprazole were equally effective for mucosal healing regardless of patient's BMI (N=542, P > 0.05). However, in overweight/obese patients, rabeprazole was significantly faster than omeprazole in inducing heartburn relief during the first treatment week (P < 0.0001). Conclusions Results of this study show that the clinical efficacy of rabeprazole is maintained in overweight/obese patients with gastroesophageal reflux disease and suggest that this subgroup of patients may derive, from rabeprazole, even greater benefit than lean patients. Eur J Gastroenterol Hepatol 23:845-851 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.