PMID- 16855986
OWN - NLM
STAT- MEDLINE
DCOM- 20061016
LR  - 20220321
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 3
DP  - 2006 Jul 19
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: Approximately 25% of adults experience heartburn, the cardinal 
      feature of gastro-oesophageal reflux disease (GORD), at least monthly. The 
      evaluation and treatment of patients with suspected GORD is associated with a 
      substantial economic burden. Most patients are treated empirically (without 
      specific diagnostic evaluation). They include a wide range of underlying 
      oesophageal injury. The severity of oesophageal injury can only be established in 
      those who have undergone upper endoscopy. Patients without visible damage to the 
      oesophagus have been referred to as having endoscopy negative reflux disease 
      (ENRD). The pathogenesis of ENRD as well as its response to treatment may differ 
      from GORD with oesophagitis. 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, treated empirically and 
      in those with endoscopy negative reflux disease (ENRD). SEARCH STRATEGY: We 
      searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 
      Issue 4, 2005), MEDLINE (January 1966 to December 2005), EMBASE (January 1988 to 
      December 2005). 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. Studies were included 
      provided that participants could be classified 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: Thirty-one trials (9457 participants) were included: fifteen in the 
      empirical treatment group, twelve in the ENRD group and four in both. In 
      empirical treatment of GORD the relative risk (RR) for heartburn remission (the 
      primary efficacy variable) 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 more effective than H2RAs (seven trials, RR 
      0.66, 95% CI 0.60 to 0.73) and prokinetics (two trials, RR 0.53, 95% CI 0.32 to 
      0.87). In treatment of ENRD, the RR for heartburn remission for PPI versus 
      placebo was 0.69 (seven trials, 95% CI 0.62 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 0.78 
      (three trials, 95% CI 0.62 to 0.97) and for PPI versus prokinetic 0.72 (one 
      trial, 95% CI 0.56 to 0.92). AUTHORS' CONCLUSIONS: PPIs are more effective than 
      H2RAs in relieving heartburn in patients with GORD who are treated empirically 
      and in those with ENRD, although the magnitude of benefit is greater for those 
      treated empirically.
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 - 20060719
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. 2004;(4):CD002095. PMID: 15495027
UIN - Cochrane Database Syst Rev. 2010;(11):CD002095. PMID: 21069670
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  - 69
EDAT- 2006/07/21 09:00
MHDA- 2006/10/17 09:00
CRDT- 2006/07/21 09:00
PHST- 2006/07/21 09:00 [pubmed]
PHST- 2006/10/17 09:00 [medline]
PHST- 2006/07/21 09:00 [entrez]
AID - 10.1002/14651858.CD002095.pub3 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2006 Jul 19;(3):CD002095. doi: 
      10.1002/14651858.CD002095.pub3.