PMID- 10796857
OWN - NLM
STAT- MEDLINE
DCOM- 20000706
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 2
DP  - 2000
TI  - Short-term treatment with proton pump inhibitors, H2-receptor antagonists and 
      prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy 
      negative reflux disease.
PG  - CD002095
AB  - BACKGROUND: Heartburn affects 25% of the adult population on a monthly basis and 
      represents the core symptom of gastro-oesophageal reflux disease (GORD). 
      Treatment is readily available and puts a large demand on healthcare budgets. 
      Research in the past has focused largely on the treatment of oesophagitis. A 
      majority of GORD patients show no endoscopic abnormalities and in daily practice 
      most patients are treated empirically. OBJECTIVES: Summarise, quantify and 
      compare the efficacy of the short-term use of proton pump inhibitors (PPI), 
      H2-receptor antagonists (H2RA) and prokinetics in the empirical treatment of GORD 
      and the treatment of endoscopy negative reflux disease (ENRD). SEARCH STRATEGY: 
      Electronic searches were performed of the Cochrane Controlled Trials Register, 
      MEDLINE and EMBASE. Bibliographies were screened. SELECTION CRITERIA: Included 
      were randomised controlled trials focussing on symptomatic outcome after 
      short-term treatment for GORD using proton pump inhibitors, H2-receptor 
      antagonists or prokinetic agents. Participants had to be classifiable in the 
      empirical treatment group (no endoscopy used in treatment allocation) or in the 
      endoscopy negative reflux disease group (no endoscopic signs of erosive 
      oesophagitis). DATA COLLECTION AND ANALYSIS: Data from included trials were 
      extracted by two reviewers independently. The impact of interventions was 
      expressed as relative risks (RR) together with 95% confidence intervals (95% CI). 
      Meta-analysis was only performed if there were sufficient trials of similar 
      comparisons reporting the same outcomes. Relative risks were combined for binary 
      outcomes. MAIN RESULTS: Twenty-one trials were included: eleven in the empirical 
      treatment group, seven in the ENRD group and three in both. In empirical 
      treatment of GORD the RR for heartburn remission in placebo-controlled trials for 
      PPI was 0.35 (1 trial, 95% CI 0.26 to 0.46), for H2RAs 0.77 (2 trials, 95% CI 
      0.60 to 0.99) and for prokinetics 0.86 (1 trial, 95% CI 0.73 to 1.01). In direct 
      comparison PPIs were significantly (p<0.05) more effective than H2RAs (3 trials, 
      RR 0.67, 95% CI 0.57 to 0.80) and prokinetic's (2 trials, RR 0.53, 95% CI 0.32 to 
      0.87). In treatment of ENRD, RR for heartburn remission for PPI versus placebo 
      was 0.68 (4 trials, 95% CI 0.53 to 0.88) and for H2RA versus placebo was 0.84 (2 
      trials, 95% CI 0.74 to 0.95). The RR for PPI versus H2RA was 0.69 (2 trials, 95% 
      CI 0.39 to 1.20) and versus prokinetic 0.72 (1 trial, 95% CI 0.56 to 0.92). 
      REVIEWER'S CONCLUSIONS: The findings in this review suggest that antisecretory 
      drugs are effective in the empirical treatment of complaints likely to originate 
      from GORD and in treatment of ENRD and furthermore that PPIs are superior to 
      H2RAs in empirical treatment of typical GORD symptoms.
FAU - van Pinxteren, B
AU  - van Pinxteren B
AD  - Department of General Practice, University Medical Center Utrecht, PO Box 80045, 
      Utrecht, Netherlands, 3508 TA. menumans@knmg.nl
FAU - Numans, M E
AU  - Numans ME
FAU - Bonis, P A
AU  - Bonis PA
FAU - Lau, J
AU  - Lau J
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Enzyme Inhibitors)
RN  - 0 (Gastrointestinal Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
UIN - Cochrane Database Syst Rev. 2001;(4):CD002095. PMID: 11687139
MH  - Endoscopy, Digestive System
MH  - Enzyme Inhibitors/*therapeutic use
MH  - Gastroesophageal Reflux/*drug therapy
MH  - Gastrointestinal Agents/*therapeutic use
MH  - Heartburn/*drug therapy
MH  - Histamine H2 Antagonists/*therapeutic use
MH  - Humans
MH  - Proton Pump Inhibitors
RF  - 29
EDAT- 2000/05/05 09:00
MHDA- 2000/07/08 11:00
CRDT- 2000/05/05 09:00
PHST- 2000/05/05 09:00 [pubmed]
PHST- 2000/07/08 11:00 [medline]
PHST- 2000/05/05 09:00 [entrez]
AID - CD002095 [pii]
AID - 10.1002/14651858.CD002095 [doi]
PST - ppublish
SO  - Cochrane Database Syst Rev. 2000;(2):CD002095. doi: 10.1002/14651858.CD002095.