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Efficacy of Drugs Used in Gastro-Oesophageal Reflux: Network Meta-Analysis

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

Image by Xun Zhang, from Flickr-cc.

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