Epigastric or
retrosternal heartburn (pyrosis) is one of the most reported conditions and is
the primary symptom of gastro-oesophageal reflux (GER). However, most people who suffer from acid reflux and pyrosis practice
self-medication and only when the situation becomes persistent or chronic do
they look for professional aid. And there is a large variety of
over-the-counter (OTC) products worldwide for symptomatic treatment of acid
reflux.
In fact, it is important to rank the clinical efficacy of different
anti-reflux agents to promote their rational use. In this study, the authors
aimed to combine the results of randomized clinical trials that had compared
the incidence of symptoms related to gastro-oesophageal
reflux (GER) with/without endoscopic evidence of oesophagitis in
a network meta-analysis and thus rank the main anti-reflux therapies
according to the magnitude of their clinical efficacy.
Inclusion
criteria: 1) randomized controlled trials that compare anti-reflux agents
(alginates (ALG), proton-pump inhibitors (PPI), H2histamine receptor
antagonists (H2RA), antacids (AA), gastrokinetics (GK)) in open
designs as compared to placebo or in comparative designs
(head-to-head); 2) outcome of interest measured in some scale representing
the significant improvement of reflux symptoms; 3) GER diagnosis with/without
oesophagitis endoscopic evidence. We collected available clinical trials for
each one of the direct comparisons. The Odds Ratio (OR) was used additionally
to calculating lnOR and its Standard Error (SE[lnOR]) to measure effects
in a network meta-analysis.
Network
meta-analysis had placebo as a reference intervention. Initial treatments
with PPI or ALG were the two interventions that significantly differed from the
others: H2RA, AA and GK. At the same time, the latter were
significantly different from the placebo. In contrast to placebo, ORs for ALG,
PPI, H2RA, AA and GK were 4.72 (95% CI: 3.39, 6.57), 4.00 (95% CI:
3.30, 4.85), 1.73 (95% CI: 1.54, 1.95), 1.41 (95% CI: 1.12,
1.76), and 1.86 (95% CI: 1.32, 2.63), respectively.
In conclusion, ALG or PPI seemed
to be the two most effective alternatives in short-time management (<12
weeks) of GER with or without oesophagitis.
Article by Rafael
Bolaños-Díaz, et al, from Perú.
Full access: http://mrw.so/II98D
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