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AIM: To clarify whether there is any difference in the symptom relief in patients with reflux esophagitis following the administration of four Proton pump inhibitors (PPIs).METHODS: Two hundred and seventy-four patients with erosive reflux esophagitis were randomized to receive 8 wk of 20 mg omeprazole ( n = 68), 30 mg of lansoprazole ( n = 69), 40 mg of pantoprazole ( n= 69), 40 mg of esomeprazole ( n = 68) once a day in the ming. Daily changes in heartb and acid reflux symptoms in the first 7 d of administration were assessed using a six-point scale (0: none; 1: mild; 2:mild-moderate; 3: moderate; 4: moderate-severe; 5:severe).RESULTS: The mean heartb score in patients treated with esomeprazole more rapidly decreased than those receiving other PPI. Complete resolution of heartb was also more rapid in patients treated with esomeprazole for 5 d compared with omeprazole ( P = 0.0018, P = 0.0098, P = 0.0027, P = 0.0137, P = 0.0069,respectively), lansoprazole ( P = 0.0020, P = 0.0046, P= 0.0037, P = 0.0016, P = 0.0076, respectively), and pantoprazole ( P = 0.0006, P = 0.0005, P = 0.0009, P =0.0031, P = 0.0119, respectively). There were no significant differences between the four groups in the rate of endoscopic healing of reflux esophagitis at week 8.CONCLUSION: Esomeprazole may be more effective than omeprazole, lansoprazole, and pantoprazole for the rapid relief of heartb symptoms and acid reflux symptoms in patients with reflux esophagitis.