Short-term treatment of gastroesophageal reflux disease
A systematic review and meta-analysis of the effect of acid-suppressant drugs in empirical treatment and in endoscopy-negative patients
Cite this article as: van Pinxteren, B., Numans, M.E., Lau, J. et al. J GEN INTERN MED (2003) 18: 755. doi:10.1046/j.1525-1497.2003.20833.x Abstract OBJECTIVE: To investigate the efficacy of acid suppressant drugs in the empirical treatment of gastroesophageal reflux disease (GERD) and in the treatment of endoscopy-negative reflux disease (ENRD). DESIGN: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched. Bibliographies were reviewed. SETTING: Studies were eligible that compared the short-term use of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H 2RAs) with each other or with placebo in adults with GERD who were enrolled irrespective of endoscopic findings (empirical cases) or in whom endoscopy showed no signs of esophagitis (endoscopy-negative cases). MEASUREMENTS: Of 1,408 studies, only 13 could be included for meta-analysis. Data on 3,433 patients empirically treated for GERD and 2,520 patients treated for ENRD were extracted. The primary endpoint was relief of heartburn. MAIN RESULTS: In the empirical treatment of GERD, the summary relative risk (sRR) for symptom relief from H 2RAs versus placebo was 0.77 (95% confidence interval [95% CI], 0.60 to 0.99). RR in the only placebo-controlled PPI trial was 0.35 (95% CI, 0.26 to 0.46). The sRR for standard dose PPIs versus H 2RAs was 0.55 (95% CI, 0.44 to 0.68). In treatment of ENRD, both PPis (sRR, 0.64; 95% CI, 0.52 to 0.79) and H 2RAs (sRR, 0.78; 95% CI, 0.62 to 0.97) were superior to placebo, and PPis were superior to H 2RAs (sRR, 0.81; 95% CI, 0.70 to 0.95). CONCLUSIONS: Acid suppressant therapy (with a PPI or an H 2RA) is more effective than placebo for short-term relief of heartburn in patients with persistent symptoms who are treated empirically for GERD and in those in whom esophagitis was excluded after endoscopy. The benefit of PPIs compared with H 2RAs is more pronounced in patients treated empirically. Key words GERD treatment PPI systematic review primary care
This research is part of the GERD-guidelines project that was initiated by the European Society for Primary Care Gastroenterology, was conducted in cooperation with the Upper Gastrointestinal and Pancreatic Diseases Group of the Cochrane Collaboration, and also was supported by a grant of the Agency for Healthcare Research and Quality of the U.S. Public Health Service, R25 HS09796.
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