Leiman D A, Riff B P, Morgan S, Metz D C, Falk G W, French B, Umscheid C A, Lewis J D
Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina.
Division of Gastroenterology, Icahn School of Medicine at Mt. Sinai, New York, New York, USA.
Dis Esophagus. 2017 May 1;30(5):1-9. doi: 10.1093/dote/dow020.
In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with nonerosive reflux disease or atypical GERD symptoms, acid-suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the postprandial gastric acid pocket. This study performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD. PubMed/MEDLINE, Embase, and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs), or PPIs for the treatment of GERD symptoms. Additional studies were identified through a bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effect models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I2 statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the meta-analysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I2 = 71%, P = .001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.
在患有胃食管反流病（GERD）和糜烂性食管炎的患者中，使用质子泵抑制剂（PPI）进行治疗非常有效。然而，在一些患者中，尤其是那些患有非糜烂性反流病或非典型GERD症状的患者，使用PPI进行抑酸治疗并不那么成功。藻酸盐是一类通过替代机制发挥作用的药物，可取代餐后胃酸袋。本研究进行了一项系统评价和荟萃分析，以检验含藻酸盐化合物在治疗GERD症状患者中的益处。通过检索PubMed/MEDLINE、Embase和Cochrane图书馆电子数据库，截至2015年10月，查找比较含藻酸盐化合物与安慰剂、抗酸剂、组胺-2受体拮抗剂（H2RA）或PPI治疗GERD症状的随机对照试验。通过文献综述确定了其他研究。排除非英语研究和涉及儿科患者的数据。使用随机效应模型进行荟萃分析以计算比值比（OR）。使用I2统计量估计研究之间的异质性。分析按对照类型分层。检索策略共获得665项研究，其中15项（2.3%）符合纳入标准。14项纳入荟萃分析（N = 2095名受试者）。与安慰剂或抗酸剂相比，基于藻酸盐的疗法提高了GERD症状缓解的几率（OR：4.42；95% CI 2.45 - 7.97），研究之间存在中度异质性（I2 = 71%，P = 0.001）。与PPI或H2RA相比，藻酸盐似乎效果较差，但汇总估计无统计学意义（OR：0.58；95% CI 0.27 - 1.22）。藻酸盐在治疗GERD症状方面比安慰剂或抗酸剂更有效。
