Xiong Ji, Lai Shujie, Zhang Piyun, Li Qing, Wei Yanling, Yang Yang, Wang Tao, Liu Lei, Ma Xiangyu, Chen Dongfeng
Department of Gastroenterology, Institute of Surgery Research, Daping Hospital (JX, SL, PZ, QL, YW, YY, TW, LL, DC); Department of Epidemiology, College of Preventive Medicine (XM); and Center for Clinical Epidemiology and Evidence-Based Medicine, Third Military Medical University, Chongqing, People's Republic of China (XM).
Medicine (Baltimore). 2014 Sep;93(12):e64. doi: 10.1097/MD.0000000000000064.
Proton pump inhibitor (PPI) was the main prescription for gastric ulcer after endoscopic submucosal dissection (ESD). Some randomized controlled trials showed that a combination of rebamipide and PPI appears to be more efficient than PPI alone for the treatment of ESD-induced gastric ulcer. However, the sample sizes in these trials were limited and the conclusions were underpowered.This meta-analysis was conducted with 5 randomized controlled trials using the combination of rebamipide and PPI for healing ESD-induced ulcer compared with PPI monotherapy. Relevant studies were searched via MEDLINE, PubMed, Embase, and Cochrane Library databases by using terms such as "rebamipide," "proton pump inhibitor," "endoscopic submucosal dissection," "drug therapy," and "gastric ulcer or artificial ulcer."Five studies were included in this meta-analysis. The number of total patients was 626, with 317 patients in the combination group and 309 patients in the PPI alone group. The heterogeneity among these 5 studies was low (I = 22%, P = 0.28). All 5 studies considered scarring stage 1 rate as a primary endpoint, and the scarring stage 1 rate in combination group (115/317) was higher than that in PPI alone group (63/309) (odds ratio 2.61, 95% confidence interval [CI] 1.76-3.88). The mean difference of initial ulcer size between 2 groups was -4.46 (95% CI -266.61 to -257.69, P = 0.97), but it enlarged to 68.38 (95% CI 35.72-101.05, P < 0.00001) in the 4th week.This meta-analysis demonstrates that combination therapy is more efficient than PPI monotherapy in healing ESD-induced gastric ulcer.
质子泵抑制剂（PPI）是内镜黏膜下剥离术（ESD）后胃溃疡的主要处方。一些随机对照试验表明，瑞巴派特与PPI联合使用在治疗ESD引起的胃溃疡方面似乎比单独使用PPI更有效。然而，这些试验的样本量有限，结论的说服力不足。本荟萃分析纳入了5项随机对照试验，比较了瑞巴派特与PPI联合使用和PPI单药治疗对ESD引起的溃疡的愈合效果。通过使用“瑞巴派特”“质子泵抑制剂”“内镜黏膜下剥离术”“药物治疗”和“胃溃疡或人工溃疡”等术语，在MEDLINE、PubMed、Embase和Cochrane图书馆数据库中检索相关研究。本荟萃分析纳入了5项研究。总患者数为626例，联合治疗组317例，PPI单药治疗组309例。这5项研究之间的异质性较低（I² = 22%，P = 0.28）。所有5项研究均将瘢痕形成1期率作为主要终点，联合治疗组的瘢痕形成1期率（115/317）高于PPI单药治疗组（63/309）（优势比2.61，95%置信区间[CI] 1.76 - 3.88）。两组初始溃疡大小的平均差值为 -4.46（95% CI -266.61至 -257.69，P = 0.97），但在第4周时扩大至68.38（95% CI 35.72 - 101.05，P < 0.00001）。本荟萃分析表明，联合治疗在愈合ESD引起的胃溃疡方面比PPI单药治疗更有效。
World J Gastroenterol. 2013-9-14
Zotero 插件