Abstract
Proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H2RAs) are used for gastro-esophageal reflux disease (GERD); however, the clinical evidence for treatment is poor. We evaluated the effectiveness and tolerability of different doses of PPIs, H2RAs and placebo in adults with GERD. Six online databases were searched through September 1, 2016. All related articles were included and combined with a Bayesian network meta-analysis from randomized controlled trials (RCTs). The GRADE systems were employed to assess the main outcome. Ninety-eight RCTs were identified, which included 45,964 participants. Our analysis indicated that the full/standard dose of esomeprazole at 40 mg per day was the most efficient in healing among nine different dosages of PPIs and H2RAs. The main efficacy outcome did not change after adjustments for the area, age, level of disease from endoscopy, year of publication, pharmaceutical industry sponsorship, Intention-to-treat (ITT)/per-protocol (PP), withdrawal rate, pre-set select design bias, single blinded and unblinded studies, study origination in China, study arms that included zero events, inconsistency node or discontinued drug were accounted for in the meta-regressions and sensitivity analyses. This research suggests that the full/standard doses (40 mg per day) of esomeprazole should be recommended as first-line treatments for GERD in adults for short-term therapy.
Highlights
gastroesophageal reflux disease (GERD) is typically caused by changes in the barrier between the stomach and the esophagus, including abnormal relaxation of the lower esophageal sphincter, which typically holds the top of the stomach closed, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia
We identified features that indicated the curative effects of pump inhibitors (PPIs) were strongly superior to the effects of histamine-2-receptor antagonists (H2RAs), and the high dose was superior to the low dose for the same intervention
Considering the clinical significance and surface under the cumulative ranking curve (SUCRA) results, the full/standard doses (40 mg per day) of esomeprazole should be recommended as first-line treatments for GERD in adults based on 4–8 weeks of short-term therapy for healing
Summary
GERD is typically caused by changes in the barrier between the stomach and the esophagus, including abnormal relaxation of the lower esophageal sphincter, which typically holds the top of the stomach closed, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. There is substantial evidence for the effectiveness and tolerability of pharmacological agents in the treatment of GERD14,17–21. Most of these findings have been obtained from pairwise comparisons within each class of drugs. A previous network meta-analysis of 27 randomized studies has indicated that PPIs were more effective as anti-reflux agents than H2RAs in terms of healing[22]. Our efforts to obtain accurate and up-to-date information regarding the properties of pharmacological interventions for GERD led us to pursue a Bayesian network meta-analysis, which combined both direct and indirect evidence for multiple treatment comparisons; these findings would inform us of the clinical efficacy and tolerability of both medication classes used in the short-term treatment of GERD
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