PMID- 15495027
OWN - NLM
STAT- MEDLINE
DCOM- 20050323
LR  - 20200511
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 4
DP  - 2004 Oct 18
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. 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 adults with GORD and endoscopy 
      negative reflux disease (ENRD). SEARCH STRATEGY: We searched the Cochrane Central 
      Register of Controlled Trials (The Cochrane Library Issue 4, 2003), MEDLINE 
      (January 1966 to December 2003), EMBASE (January 1988 to December 2003). 
      SELECTION CRITERIA: 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: Two reviewers independently assessed 
      trial quality and extracted data. MAIN RESULTS: Twenty-seven trials (8402 
      participants) were included: thirteen in the empirical treatment group, ten in 
      the ENRD group and four in both. In empirical treatment of GORD the relative risk 
      (RR) for heartburn remission in placebo-controlled trials for PPI was 0.37 (two 
      trials, 95% confidence interval (CI) 0.32 to 0.44), for H2RAs 0.77 (two trials, 
      95% CI 0.60 to 0.99) and for prokinetics 0.86 (one trial, 95% CI 0.73 to 1.01). 
      In a direct comparison PPIs were significantly (p < 0.05) more effective than 
      H2RAs (five trials, RR 0.69, 95% CI 0.61 to 0.77) and prokinetics (two 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 (six trials, 95% CI 0.59 to 0.78) and for H2RA versus 
      placebo was 0.84 (two trials, 95% CI 0.74 to 0.95). The RR for PPI versus H2RA 
      was 0.74 (three trials, 95% CI 0.53 to 1.03) and for PPI versus prokinetic 0.72 
      (one trial, 95% CI 0.56 to 0.92). REVIEWERS' 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
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  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20041018
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
UOF - Cochrane Database Syst Rev. 2001;(4):CD002095. PMID: 11687139
UIN - Cochrane Database Syst Rev. 2006;(3):CD002095. PMID: 16855986
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
MH  - Randomized Controlled Trials as Topic
RF  - 63
EDAT- 2004/10/21 09:00
MHDA- 2005/03/24 09:00
CRDT- 2004/10/21 09:00
PHST- 2004/10/21 09:00 [pubmed]
PHST- 2005/03/24 09:00 [medline]
PHST- 2004/10/21 09:00 [entrez]
AID - 10.1002/14651858.CD002095.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2004 Oct 18;(4):CD002095. doi: 
      10.1002/14651858.CD002095.pub2.