Ang Daphne, Zheng Qishi, Shi Luming, Tack Jan
Department of Gastroenterology, Changi General Hospital, Singapore.
Department of Epidemiology, Singapore Clinical Research Institute, Singapore.
United European Gastroenterol J. 2018 Nov;6(9):1294-1306. doi: 10.1177/2050640618772787. Epub 2018 Apr 20.
Patients with persistent gastroesophageal reflux disease symptoms despite proton pump inhibitors are increasingly encountered. It remains controversial if proton pump inhibitors should be stopped before functional oesophageal tests.
This meta-analysis compares the positive yield of oesophageal studies performed off versus on proton pump inhibitors.
Pubmed, Embase and the Cochrane Library were searched for eligible studies. Outcomes assessed were the number of subjects with: elevated oesophageal acid exposure time when studied off versus on proton pump inhibitors; positive symptom index (≥50%) and/or positive symptom association probability (≥95%) for acid reflux; and/or non-acid reflux events off versus on proton pump inhibitors. The random effects model was applied.
Fifteen studies ( = 5033 individuals; 33% on proton pump inhibitors; 32% men; mean age 52.1 years) were analysed. Pooled risk ratio for the comparison of high oesophageal acid exposure time off versus on proton pump inhibitors was 2.16 (95% confidence interval (CI) 1.42-3.28). The risk ratio of a positive symptom index (acid reflux) was 2.64 (95% CI 1.52-4.57) and the risk ratio of a positive symptom association probability (acid reflux) was 2.94 (95% CI 2.31-3.74). Conversely, the risk ratio of a positive symptom index (non-acid reflux) was 0.96 (95% CI 0.49-1.88) and risk ratio of a positive symptom association probability (non-acid reflux) was 0.54 (95% CI 0.30-0.99).
Oesophageal studies after proton pump inhibitor cessation improve the positive yield for acid reflux-related events but reduce the detection of symptomatic non-acid reflux events.
尽管使用了质子泵抑制剂，但仍有越来越多的患者出现持续性胃食管反流病症状。在进行功能性食管检查前是否应停用质子泵抑制剂仍存在争议。
本荟萃分析比较了在停用与继续使用质子泵抑制剂的情况下进行食管检查的阳性率。
检索了Pubmed、Embase和Cochrane图书馆中的符合条件的研究。评估的结果包括：在停用与继续使用质子泵抑制剂时进行研究的受试者中，食管酸暴露时间升高的人数；酸反流的阳性症状指数（≥50%）和/或阳性症状关联概率（≥95%）；和/或停用与继续使用质子泵抑制剂时的非酸反流事件。应用随机效应模型。
分析了15项研究（n = 5033人；33%继续使用质子泵抑制剂；32%为男性；平均年龄52.1岁）。停用与继续使用质子泵抑制剂时食管酸暴露时间高的比较的合并风险比为2.16（95%置信区间（CI）1.42 - 3.28）。阳性症状指数（酸反流）的风险比为2.64（95%CI 1.52 - 4.57），阳性症状关联概率（酸反流）的风险比为2.94（95%CI 2.31 - 3.74）。相反，阳性症状指数（非酸反流）的风险比为0.96（95%CI 0.49 - 1.88），阳性症状关联概率（非酸反流）的风险比为0.54（95%CI 0.30 - 0.99）。
停用质子泵抑制剂后进行食管检查可提高酸反流相关事件的阳性率，但会减少有症状的非酸反流事件的检测。
