The management of GORD involves maintaining intragastric pH above 4.0, crucial for symptom relief and mucosal healing. Proton pump inhibitors (PPIs) are the cornerstone of GORD treatment due to their efficacy in acid suppression and symptom control. Among the available PPIs, dexlansoprazole has shown superior efficacy, particularly in maintaining pH >4, compared to esomeprazole.

Gastro-oesophageal reflux disease (GORD) remains a prevalent challenge in clinical practice, affecting a significant portion of the population with symptoms that impair quality of life and increase healthcare costs.

The management of GORD involves maintaining intragastric pH above 4.0, crucial for symptom relief and mucosal healing. Proton pump inhibitors (PPIs) are the cornerstone of GORD treatment due to their efficacy in acid suppression and symptom control. Among the available PPIs, dexlansoprazole has shown superior efficacy, particularly in maintaining pH >4, compared to esomeprazole. A pivotal study by Kukulka et al. demonstrated that dexlansoprazole modified-release 60mg maintained a higher mean pH and a greater percentage of time with pH above 4 over 24 hours than esomeprazole 40mg. This is particularly significant in the 12-24-hour interval post-dose, highlighting its strength in controlling nocturnal acid breakthrough, a common issue in GORD management.

Dexlansoprazole uses a novel dual delayed release (DDR) technology, which allows for two separate releases of the medication – the first occurring within an hour of dosing and the second released four to five hours later.

This unique mechanism ensures prolonged acid suppression, making it highly effective for patients with persistent symptoms and those who experience nocturnal reflux. Clinical trials and real-world studies have consistently shown that dexlansoprazole not only improves GORD symptoms but also enhances patient compliance and quality of life.

It is effective in healing erosive esophagitis and maintaining healed mucosa with a once-daily dosing regimen, which can be administered without regard to meals – a significant advantage in treatment adherence.

The pharmacological profile of dexlansoprazole, as detailed by Goh et al., indicates minimal interaction with common co-medications such as clopidogrel, making it a safer choice in polypharmacy scenarios, often seen in the elderly population. Additionally, its efficacy is not significantly impacted by the variability in CYP2C19 enzyme activity, a common issue with other PPIs.

Conclusion

In conclusion, dexlansoprazole's advanced formulation and pharmacodynamic properties position it as a leading treatment option in the management of GORD. Its ability to maintain a higher intragastric pH for a longer duration compared to esomeprazole, coupled with its patient-friendly dosing schedule, provides a compelling case for its preferred use in clinical practice across South Africa.

References 

1. Kukulka M, et al. Comparative study on dexlansoprazole vs. esomeprazole on intragastric pH. Takeda Pharmaceuticals.
2. Goh KL. Pharmacological and safety profile of dexlansoprazole. Journal of Gastroenterology.
3. Dent J, et al.Genval Workshop Report on GORD management. Supported by Astra.
4. Gasiorowska A. The role of pH in symptomatic
   relief in GORD. Journal of Clinical Gastroenterology.
5. Armstrong D. Review on gastric pH as a
   predictor of reflux disease benefit. Clinical Gastroenterology Review.