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The treatment efficacy of adding prokinetics to PPIs for gastroesophageal reflux disease: a meta-analysis

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Abstract

Background

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder. Proton pump inhibitors (PPIs) are first-line drugs for GERD. For those who fail to respond to PPIs, adding prokinetics to PPIs is recommended and several trials have been conducted to evaluate the efficacy of prokinetic–PPI combination therapy.

Methods

A systematic literature search was performed using PubMed and the Cochrane Library databases before February 2019 for randomized controlled trials (RCTs), which compared the efficacy of prokinetics plus PPI treatment with that of PPI monotherapy. Relevant studies were examined and data were extracted independently by two investigators. The risk ratios (RRs) with 95% CIs were used to evaluate the responder rate, and standard mean differences (SMDs) or mean differences (MDs) with 95% CIs were used for symptom score changes. Statistical heterogeneity was evaluated by the I2 statistic. Either a fixed-effect or a random-effect model was established for calculating the pooled data.

Results

A total of 14 studies, comprising 1,437 patients were ultimately included in the meta-analysis. The pooled analysis showed that compared to PPI monotherapy, addition of prokinetics to PPI did not elevate the rate of endoscopic responders (RR = 0.996, 95% CI 0.929 − 1.068, p = 0.917), but improved symptom response (RR = 1.185, 95% CI 1.042 − 1.348, p = 0.010). Additionally, the combined therapy achieved a greater symptom relief than monotherapy both in FSSG and GERD-Q subgroups (MD =  − 2.978, 95% CI  − 3.319 to  − 2.638, p < 0.001; MD =  − 0.723, 95% CI  − 0.968 to  − 0.478, p < 0.001).

Conclusions

Adding prokinetics to PPIs achieves symptomatic improvement compared to PPI monotherapy, thus can enhance life quality of GERD patients. However, the combined treatment seems to have no significant effect on mucosal healing.

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Funding

The work was supported by Jiangsu Provincial Key Research and Development Plan (No. BE2018659) and Provincial Key Laboratory Program of Higher Education (No. KJS1867).

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Author notes

  1. Liting Xi and Jinzhou Zhu have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China

    Liting Xi, Jinzhou Zhu, Huixian Zhang & Airong Wu

  2. Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China

    Merlin Muktiali

  3. College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China

    Youming Li

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  1. Liting Xi
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Correspondence to Airong Wu.

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All analyses were based on previous published studies, thus no ethical approval and patient consent are required.

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10388_2020_753_MOESM1_ESM.tif

Supplementary Figure 1 Sensitivity analysis in which the meta-analysis of symptom score changes is re-estimated by omitting each study in turn (TIF 1498 kb)

10388_2020_753_MOESM2_ESM.tif

Supplementary Figure 2 Meta-analysis of the symptom response. a: symptom response in NERD patients; b: symptom response in RE patients (TIF 5366 kb)

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Xi, L., Zhu, J., Zhang, H. et al. The treatment efficacy of adding prokinetics to PPIs for gastroesophageal reflux disease: a meta-analysis. Esophagus 18, 144–151 (2021). https://doi.org/10.1007/s10388-020-00753-6

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  • DOI: https://doi.org/10.1007/s10388-020-00753-6

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