Meta-Analysis
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World J Gastroenterol. Dec 7, 2013; 19(45): 8408-8419
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8408
Proton pump inhibitor for non-erosive reflux disease: A meta-analysis
Ji-Xiang Zhang, Meng-Yao Ji, Jia Song, Hong-Bo Lei, Shi Qiu, Jing Wang, Ming-Hua Ai, Jun Wang, Xiao-Guang Lv, Zi-Rong Yang, Wei-Guo Dong
Ji-Xiang Zhang, Meng-Yao Ji, Jia Song, Hong-Bo Lei, Shi Qiu, Jing Wang, Ming-Hua Ai, Jun Wang, Xiao-Guang Lv, Zi-Rong Yang, Wei-Guo Dong, Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Author contributions: Zhang JX and Dong WG designed the research; Zhang JX, Yang ZR and Lv XG performed the research; Zhang JX, Song J, Qiu S, Ai MH and Wang J analyzed the data; Zhang JX wrote the paper; Yang ZR and Dong WG reviewed and revised the paper.
Correspondence to: Wei-Guo Dong, MD, PhD, Department of Gastroenterology, Renmin Hospital of Wuhan University, Ziyang Road 99, Wuhan 430060, Hubei Province, China. dwg@whu.edu.cn
Telephone: +86-27-88041911 Fax: +86-27-88042292
Received: July 10, 2013
Revised: September 4, 2013
Accepted: September 16, 2013
Published online: December 7, 2013
Processing time: 160 Days and 12.7 Hours
Abstract

AIM: To evaluate the efficacy, safety and influential factors of proton pump inhibitor (PPI) treatment for non-erosive reflux disease (NERD).

METHODS: PubMed, MEDLINE, EMBASE and the Cochrane Library were searched up to April 2013 to identify eligible randomized controlled trials (RCTs) that probed into the efficacy, safety and influential factors of PPI treatment for NERD. The rates of symptomatic relief and adverse events were measured as the outcomes. After RCT selection, assessment and data collection, the pooled RRs and 95%CI were calculated. This meta-analysis was performed using the Stata 12.0 software (Stata Corporation, College Station, Texas, United States). The level of evidence was estimated by the Grading of Recommendations Assessment, Development and Evaluation system.

RESULTS: Seventeen RCTs including 6072 patients met the inclusion criteria. The results of the meta-analysis showed that PPI treatment was significantly superior to H2 receptor antagonists (H2RA) treatment (RR = 1.629, 95%CI: 1.422-1.867, P = 0.000) and placebo (RR = 1.903, 95%CI: 1.573-2.302, P = 0.000) for the symptomatic relief of NERD. However, there were no obvious differences between PPI and H2RA (RR = 0.928, 95%CI: 0.776-1.110, P = 0.414) or PPI and the placebo (RR = 1.000, 95%CI: 0.896-1.116, P = 0.997) regarding the rate of adverse events. The overall rate of symptomatic relief of PPI against NERD was 51.4% (95%CI: 0.433-0.595, P = 0.000), and relief was influenced by hiatal hernia (P = 0.030). The adverse rate of PPI against NERD was 21.0% (95%CI: 0.152-0.208, P = 0.000), and was affected by hiatal hernia (P = 0.081) and drinking (P = 0.053).

CONCLUSION: PPI overmatched H2RA on symptomatic relief rate but not on adverse rate for NERD. Its relief rate and adverse rate were influenced by hiatal hernia and drinking.

Keywords: Proton pump inhibitor; Non-erosive reflux disease; Symptomatic relief; Adverse event; Meta-analysis

Core tip: As a kind of powerful and effective acid-suppressive drugs, proton pump inhibitor (PPI) has been used for patients with non-erosive reflux disease (NERD), but its efficacy, safety and their influential factors are inconclusive. We performed this systematic review and meta-analysis of randomized controlled trials to assess its efficacy, safety and influential factors. Based on the results of the meta-analysis, we conclude that PPI has a higher symptomatic relief rate and roughly the same adverse rate for NERD. Hiatal hernia and drinking could influence symptomatic relief rate and adverse rate of PPI on NERD.