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Efficacy of Drugs Used in gastro-oesophageal reflux:Network Meta-Analysis

Pharmacology & Pharmacy 2013年第2期4卷 201-208页

作者： Rafael Bolanos-Díaz Hector Velarde-Criado Erik Condor-Mori Unidad de Analisis y Generacion de Evidencias en Salud Publica(UNAGESP) Instituto Nacional de Salud(INS)LimaPeru Departamento de gastroenterología Hospital Central de AeronauticaLimaPeru Unidad de Epidemiología Clínica Universidad Peruana Cayetano HerediaLimaPeru

Introduction: It is important to rank the clinical efficacy of different anti-reflux agents to promote their rational use. Objective: To combine the results of randomized clinical trials that have compared the incidence of symptoms related to gastro-oesophageal reflux (GER) with/without endoscopic evidence of oesophagitis in a network meta-analysis and thus rank the main anti-reflux therapies according to the magnitude of their clinical efficacy. Method: Inclusion criteria: 1) randomized controlled trials that compare anti-reflux agents (alginates (ALG), proton-pump inhibitors (PPI), H2 histamine receptor antagonists (H2RA), antacids (AA), gastrokinetics (GK)) in open designs as compared to placebo or in comparative designs (head-to-head);2) outcome of interest measured in some scale representing the significant improvement of reflux symptoms;3) GER diagnosis with/without oesophagitis endoscopic evidence. We collected available clinical trials for each one of the direct comparisons. The Odds Ratio (OR) was used additionally to calculating lnOR and its Standard Error (SE[lnOR]) to measure effects in a network meta-analysis. Results: Network meta-analysis has placebo as a reference intervention. Initial treatments with PPI or ALG are the two interventions that significantly differ from the others: H2RA, AA and GK. At the same time, the latter are significantly different from the placebo. In contrast to placebo, ORs for ALG, PPI, H2RA, AA and GK were 4.72 (95% CI: 3.39, 6.57), 4.00 (95% CI: 3.30, 4.85), 1.73 (95% CI: 1.54, 1.95), 1.41 (95% CI: 1.12, 1.76), and 1.86 (95% CI: 1.32, 2.63), respectively. Conclusion: ALG or PPI seem to be the two most effective alternatives in short-time management of GER with or without oesophagitis.

关键词： gastro-oesophageal reflux Network Meta-Analysis

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Percutaneous endoscopic gastrostomy and gastrooesophageal reflux in neurologically impaired children

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World Journal of gastroenterology 2011年第2期17卷 191-196页

作者： Mike Thomson Prithviraj Rao David Rawat Tobias G Wenzl Centre for Paediatric gastroenterology Royal Free and University College Medical School Centre for Paediatric gastroenterology Sheffield Childrens NHS TrustWestern BankSheffieldS10 2TH United Kingdom Kinderklinik Universittsklinikum Aachen

AIM:To investigate the effects of percutaneous endoscopic gastrostomy(PEG) feeding on gastro-oesophageal reflux(GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance(pH/MII) . METHODS:Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement. METHODS:Prior to PEG placement(pre-PEG) a total of 183 GOR episodes were detected,156(85.2%) were *** PEG placement(post-PEG) a total of 355 episodes were detected,182(51.3%) were *** total number of distal acid reflux events statistically significantly increased post-PEG placement(prePEG total 27,post-PEG total 173,P=0.028) and themean distal pH decreased by 1.1 *** distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25(0-2) ,post-PEG 2.95(0-40) ].Average proximal pH was lower post-PEG but the within subject difference was not statistically significant(P=0.058) . Median number of non-acid GOR,average reflux height,total acid clearance time and total bolus clearance time were all lower pre-PEG,but not statistically significant. CONCLUSION:PEG placement increases GOR episodes in neurologically impaired children.

关键词： Percutaneous endoscopic gastrostomy gastro-oesophageal reflux Multiple intraluminal impedance

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Does (supra)gastric belching trigger recurrent hiccups?

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World Journal of gastroenterology 2010年第14期16卷 1795-1799页

作者： Wim P Hopman Mariёtte C van Kouwen André J Smout Department o gastroenterology and Hepatology Radboud University Nijme gen Medical Centre 6500 HB Nijmegen The Netherlands Department of gastroenterology and Hepa tology Academic Medical Center PO Box 22660 1100 DD Amsterdam The Netherlands

Twenty-four hours multichannel intraesophageal impedance and pH monitoring in a patient who suffered from recurrent hiccups for more than a year revealed frequent supragastric belching and pathological oesophageal acid exposure. Furthermore, a temporal relationship between the start of a hiccup episode and gastric belching was observed. The data support the hypothesis that there is an association between supragastric belching, persistent recurrent hiccups and gastro-oesophageal reflux disease, and that gastric belching may evoke hiccup attacks.

关键词： Hiccup Impedance and pH monitoring gastro-oesophageal reflux Supragastric belching

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Risk factors for Barrett’s oesophagus and oesophageal adenocarcinoma:Results from the FINBAR study

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World Journal of gastroenterology 2007年第10期13卷 1585-1594页

作者： Lesley A Anderson RG Peter Watson Seamus J Murphy Brian T Johnston Harry Comber Jim Mc Guigan John V Reynolds Liam J Murray Centre for Clinical and Population Sciences Queen's UniversityBelfastNorthern Ireland Royal Group of Hospitals BelfastNorthern Ireland National Cancer Registry CorkIreland St.James's Hospital DublinIreland

AIM:To investigate risk factors associated with Barrett's oesophagus and oesophageal ***:This all-Ireland population-based case-control study recruited 224 Barrett's oesophagus patients,227 oesophageal adenocarcinoma patients and 260 *** participants underwent a structured interview with information obtained about potential lifestyle and environmental risk ***:gastro-oesophageal reflux was associated with Barrett's [OR 12.0(95% CI 7.64-18.7)] and oesophageal adenocarcinoma [OR 3.48(95% CI 2.25-5.41)].oesophageal adenocarcinoma patients were more likely than controls to be ex-or current smokers [OR 1.72(95% CI 1.06-2.81)and OR 4.84(95% CI 2.72-8.61)respectively] and to have a high body mass index [OR 2.69(95% CI 1.62-4.46)].No significant associations were observed between these risk factors and Barrett's *** but not vegetables were negatively associated with oesophageal adenocarcinoma [OR 0.50(95% CI 0.30-0.86)].CONCLUSION:A high body mass index,a diet low in fruit and cigarette smoking may be involved in the progression from Barrett's oesophagus to oesophageal adenocarcinoma.

关键词： Barrett's oesophagus oesophagealadenocarcinoma Smoking gastro-oesophageal reflux Body mass index Diet Case-control

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