Systematic review with network meta-analysis: indirect comparison of the efficacy of vonoprazan and proton-pump inhibitors for maintenance treatment of gastroesophageal reflux disease

Abstract Gastroesophageal reflux disease (GERD) is a widely studied and highly prevalent condition. However, few is reported about the exact efficacy and safety of fundoplication (FPT) compared to oral intake proton-pump inhibitors (PPI). This systematic review and meta-analysis of randomized clinical trials (RCT) aims to compare PPI and FPT in relation to the efficacy, as well as the adverse events associated with these therapies. Methods This systematic review was guided by PRISMA statement. Search carried out in June 2020 was conducted on Medline, Cochrane, EMBASE and LILACS. The inclusion criteria were (I) patients with GERD; (II) Randomized clinical trials, comparing oral intake PPI with FPT; (III) relevant outcomes for this review. The exclusion criteria were (I) reviews, case reports, editorials and letters (II) transoral or endoscopic FPT (III) studies with no full text. No restrictions were set for language or period. Certainty of evidence and risk of bias were assessed with GRADE Pro and with Review Manager Version 5.4 bias assessment tool. Results Ten RCT were included. Meta-analysis showed that heartburn (RD = −0.19; 95% CI = −0.29, −0.09) was less frequently reported by patients that underwent FPT. Furthermore, patients undergoing surgery had greater pressure on the lower esophageal sphincter than those who used PPI (MD = 7.81; 95% CI 4.79, 10.83). There was no significant difference between groups in the percentage of time with pH less than 4 in 24 hours, sustained remission and Gastrointestinal Symptom Rating Scale. Finally, FPT did not increase significantly the risk for adverse events such as postoperative dysphagia and impaired belching. Conclusion FPT is a more effective therapy than PPI treatment for GERD, without significantly increasing the risk for adverse events. However, before indicating a possible surgical approach, it is extremely important to correctly assess and select the patients who would benefit from FPT, such as those with severe erosive esophagitis, severe respiratory symptoms, low adherence to continuous drug treatment and patients with non-acid reflux, to ensure better results.

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Vonoprazan versus proton‐pump inhibitors for healing gastroesophageal reflux disease: A systematic review

Journal of Gastroenterology and Hepatology ◽

10.1111/jgh.14664 ◽

2019 ◽

Cited By ~ 4

Author(s):

Hirota Miyazaki ◽

Ataru Igarashi ◽

Toshihisa Takeuchi ◽

Lida Teng ◽

Akihito Uda ◽

...

Keyword(s):

Systematic Review ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Reflux Disease

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Efficacy of Laparoscopic Nissen Fundoplication vs Transoral Incisionless Fundoplication or Proton Pump Inhibitors in Patients With Gastroesophageal Reflux Disease: Misleading Ranking Probabilities in Network Meta-analysis

Gastroenterology ◽

10.1053/j.gastro.2018.02.042 ◽

2018 ◽

Vol 155 (3) ◽

pp. 935-936 ◽

Cited By ~ 2

Author(s):

Barham Abu Dayyeh ◽

M. Hassan Murad ◽

Fateh Bazerbachi ◽

Navtej S. Buttar ◽

Venkat Akshintala ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Reflux Disease ◽

Nissen Fundoplication ◽

Meta Analysis ◽

Laparoscopic Nissen Fundoplication ◽

Transoral Incisionless Fundoplication ◽

Laparoscopic Nissen

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ANTISECRETORY TREATMENT FOR PEDIATRIC GASTROESOPHAGEAL REFLUX DISEASE - A SYSTEMATIC REVIEW

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201700000-42 ◽

2017 ◽

Vol 54 (4) ◽

pp. 271-280 ◽

Cited By ~ 6

Author(s):

Ângelo Zambam de MATTOS ◽

Gabriela Meirelles MARCHESE ◽

Bárbara Brum FONSECA ◽

Carlos KUPSKI ◽

Marta Brenner MACHADO

Keyword(s):

Systematic Review ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Reflux Disease ◽

Receptor Antagonists ◽

H2 Receptor Antagonists ◽

Histamine H2 Receptor ◽

H2 Receptor

ABSTRACT BACKGROUND: Proton pump inhibitors and histamine H2 receptor antagonists are two of the most commonly prescribed drug classes for pediatric gastroesophageal reflux disease, but their efficacy is controversial. Many patients are treated with these drugs for atypical manifestations attributed to gastroesophageal reflux, even that causal relation is not proven. OBJECTIVE: To evaluate the use of proton pump inhibitors and histamine H2 receptor antagonists in pediatric gastroesophageal reflux disease through a systematic review. METHODS: A systematic review was performed, using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases. The search was limited to studies published in English, Portuguese or Spanish. There was no limitation regarding date of publication. Studies were considered eligible if they were randomized-controlled trials, evaluating proton pump inhibitors and/or histamine H2 receptor antagonists for the treatment of pediatric gastroesophageal reflux disease. Studies published only as abstracts, studies evaluating only non-clinical outcomes and studies exclusively comparing different doses of the same drug were excluded. Data extraction was performed by independent investigators. The study protocol was registered at PROSPERO platform (CRD42016040156). RESULTS: After analyzing 735 retrieved references, 23 studies (1598 randomized patients) were included in the systematic review. Eight studies demonstrated that both proton pump inhibitors and histamine H2 receptor antagonists were effective against typical manifestations of gastroesophageal reflux disease, and that there was no evidence of benefit in combining the latter to the former or in routinely prescribing long-term maintenance treatments. Three studies evaluated the effect of treatments on children with asthma, and neither proton pump inhibitors nor histamine H2 receptor antagonists proved to be significantly better than placebo. One study compared different combinations of omeprazole, bethanechol and placebo for the treatment of children with cough, and there is no clear definition on the best strategy. Another study demonstrated that omeprazole performed better than ranitidine for the treatment of extraesophageal reflux manifestations. Ten studies failed to demonstrate significant benefits of proton pump inhibitors or histamine H2 receptor antagonists for the treatment of unspecific manifestations attributed to gastroesophageal reflux in infants. CONCLUSION: Proton pump inhibitors or histamine H2 receptor antagonists may be used to treat children with gastroesophageal reflux disease, but not to treat asthma or unspecific symptoms.

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