PMID- 21069670
OWN - NLM
STAT- MEDLINE
DCOM- 20101206
LR  - 20220409
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 11
DP  - 2010 Nov 10
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
LID - 10.1002/14651858.CD002095.pub4 [doi]
AB  - BACKGROUND: Approximately 25% of adults regularly experience heartburn, a symptom 
      of gastro-oesophageal reflux disease (GORD). Most patients are treated 
      empirically (without specific diagnostic evaluation e.g. endoscopy. Among 
      patients who have an upper endoscopy, findings range from a normal appearance, 
      mild erythema to severe oesophagitis with stricture formation. Patients without 
      visible damage to the oesophagus have endoscopy negative reflux disease (ENRD). 
      The pathogenesis of ENRD, and its response to treatment may differ from GORD with 
      oesophagitis. OBJECTIVES: Summarise, quantify and compare the efficacy of 
      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 MEDLINE 
      (January 1966 to November 2008), EMBASE (January 1988 to November 2008), and EBMR 
      in November 2008. SELECTION CRITERIA: Randomised controlled trials reporting 
      symptomatic outcome after short-term treatment for GORD using proton pump 
      inhibitors, H2-receptor antagonists or prokinetic agents. Participants had to be 
      either from an empirical treatment group (no endoscopy used in treatment 
      allocation) or from an endoscopy negative reflux disease group (no signs of 
      erosive oesophagitis). DATA COLLECTION AND ANALYSIS: Two authors independently 
      assessed trial quality and extracted data. MAIN RESULTS: Thirty-two trials (9738 
      participants) were included: fifteen in the empirical treatment group, thirteen 
      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 0.73 (eight trials, 95% CI 
      0.67 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, Bart
AU  - van Pinxteren B
AD  - Julius Center for Health Sciences and Primary Care, University Medical Center 
      Utrecht, PO Box 85500, Utrecht, Netherlands, 3508 GA.
FAU - Sigterman, Kirsten E
AU  - Sigterman KE
FAU - Bonis, Peter
AU  - Bonis P
FAU - Lau, Joseph
AU  - Lau J
FAU - Numans, Mattijs E
AU  - Numans ME
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20101110
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. 2006;(3):CD002095. PMID: 16855986
UIN - Cochrane Database Syst Rev. 2013;5:CD002095. PMID: 23728637
MH  - Adult
MH  - Enzyme Inhibitors/*therapeutic use
MH  - Esophagoscopy
MH  - Gastroesophageal Reflux/*drug therapy
MH  - Gastrointestinal Agents/*therapeutic use
MH  - Gastroscopy
MH  - Heartburn/*drug therapy
MH  - Histamine H2 Antagonists/*therapeutic use
MH  - Humans
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Randomized Controlled Trials as Topic
EDAT- 2010/11/12 06:00
MHDA- 2010/12/14 06:00
CRDT- 2010/11/12 06:00
PHST- 2010/11/12 06:00 [entrez]
PHST- 2010/11/12 06:00 [pubmed]
PHST- 2010/12/14 06:00 [medline]
AID - 10.1002/14651858.CD002095.pub4 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2010 Nov 10;(11):CD002095. doi: 
      10.1002/14651858.CD002095.pub4.