Proton Pump Inhibitors, H2-Receptor Antagonists and Prokinetics for Gastro-Oesophageal Reflux

A Cochrane review [Abstract] 1 included 34 studies (15 in the empirical treatment group, 15 in the endoscopy negative reflux disease group and 4 in both) with a total of 13140 participants.

In empirical treatment of gastro-oesophageal reflux disease (GORD), the relative risk (RR) for heartburn remission (the primary efficacy variable) in placebo-controlled trials for proton pump inhibitors (PPI) was 0.37 (2 trials, 95% CI 0.32 to 0.44), for H2-receptor antagonists (H2RA) 0.77 (2 trials, 95% CI 0.60 to 0.99) and for prokinetics 0.86 (1 trial, 95% CI 0.73 to 1.01). In a direct comparison PPIs were more effective than H2RAs (7 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 endoscopy negative reflux, the RR for heartburn remission for PPI versus placebo was 0.71 (ten trials, 95% CI 0.65 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).

The following decision support rules contain links to this evidence summary:

• PPIs for maintenance therapy of reflux oesophagitis http://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00513&country=UK

References

• Sigterman KE, van Pinxteren B, Bonis PA et al. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev 2013;(5):CD002095. [PubMed]