Sugimoto Mitsushige, Murata Masaki, Mizuno Hitomi, Iwata Eri, Nagata Naoyoshi, Itoi Takao, Kawai Takashi
Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Shinjuku, Tokyo 160-0023, Japan.
Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan.
J Clin Med. 2020 Sep 18;9(9):3007. doi: 10.3390/jcm9093007.
The etiology of gastroesophageal reflux disease (GERD) including reflux esophagitis and non-erosive reflux disease is multifactorial and a recent meta-analysis showed no association between the development of GERD and eradication in both Western and East-Asian populations. However, the problem remains that various inclusion criteria are used in these studies, which hinders meta-analysis. With a focus on reflux esophagitis with endoscopic mucosal injury, we meta-analysed to evaluate the association between eradication and reflux esophagitis and symptoms using a clearly defined set of inclusion criteria. We conducted a meta-analysis of studies published up until March 2020, which compared the incidence of reflux esophagitis and symptoms between patients undergoing eradication therapy in a randomized placebo-controlled trial (Category A); between patients with successful and failed eradication (Category B); and between patients with successful vs. failed eradication, receipt of placebo, or no-treatment -positives (Category C). A total of 27 studies were included. Significant statistical effects were found for development of endoscopic reflux esophagitis [relative risk (RR): 1.46, 95% confidence interval (CI): 1.16-1.84, = 0.01] or reflux esophagitis (RR: 1.42, 95% CI: 1.01-2.00, = 0.03) in the case group that received eradication in all studies, especially in Western populations. There was no significant difference in the incidence of symptoms after eradication between patient and control groups, regardless of category, location of population, or baseline disease. Eradication therapy for increases the risk of reflux esophagitis, irrespective of past history of esophagitis. In contrast, no effect was seen on reflux-related symptoms.
胃食管反流病（GERD），包括反流性食管炎和非糜烂性反流病，其病因是多因素的，最近一项荟萃分析表明，在西方和东亚人群中，GERD的发生与根除治疗之间没有关联。然而，问题在于这些研究使用了各种纳入标准，这妨碍了荟萃分析。以伴有内镜下黏膜损伤的反流性食管炎为重点，我们进行了荟萃分析，以使用明确界定的一组纳入标准来评估根除治疗与反流性食管炎及症状之间的关联。我们对截至2020年3月发表的研究进行了荟萃分析，这些研究比较了在随机安慰剂对照试验中接受根除治疗的患者（A类）之间反流性食管炎和症状的发生率；成功根除与未成功根除的患者之间（B类）；以及成功根除与未成功根除、接受安慰剂或未治疗的阳性患者之间（C类）。总共纳入了27项研究。在所有研究中接受根除治疗的病例组中，内镜下反流性食管炎的发生[相对危险度（RR）：1.46，95%置信区间（CI）：1.16 - 1.84，P = 0.01]或反流性食管炎（RR：1.42，95% CI：1.01 - 2.00，P = 0.03）有显著统计学效应，尤其是在西方人群中。无论类别、人群位置或基线疾病如何，根除治疗后患者组和对照组症状的发生率没有显著差异。根除治疗会增加反流性食管炎的风险，无论既往是否有食管炎病史。相比之下，对反流相关症状没有影响。
