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Evidence summaries

Proton-Pump Inhibitors for Non-Erosive Reflux Disease

Proton-pump inhibitors are effective for heartburn in non-erosive reflux disease, but the benefit may be less than for erosive esophagitis. Level of evidence: "A"

A systematic review 1 including 7 studies on non-erosive reflux disease (NERD) with a total of 1,854 subjects was abstracted in DARE. The patients with NERD had symptoms of gastroesophageal reflux disease and negative upper endoscopy. Two RCTs were used to assess the effects of PPIs in patients with EE (n=705). Patients treated with PPIs were significantly more likely to achieve complete or sufficient control of heartburn compared with placebo-treated patients. In general, the pooled RD between PPI and placebo groups ranged from 0.3 to 0.35 for sufficient control, and from 0.25 to 0.3 for complete control. In an indirect comparison, complete resolution of heartburn symptoms at 4 weeks was more common in patients with EE than in those with NERD (56% versus 37%, P<0.00001). There was no significant difference between patients with NERD or EE in response rates with placebo (9.5% versus 7.5%, P>0.05).

    References

    • Dean BB, Gano AD, Knight K, Ofman JJ, Fass R. Effectiveness of proton pump inhibitors in nonerosive reflux disease Clin Gastroenter Hepatol 2005;2:656-664. [DARE]

Primary/Secondary Keywords