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Sci Rep. 2017 Jan 19;7:41021. doi: 10.1038/srep41021.

Effectiveness and Tolerability of Different Recommended Doses of PPIs and H2RAs in GERD: Network Meta-Analysis and GRADE system.

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Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China.
Chinese Cochrane Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University and Global Health Institute, Wuhan University, Wuhan 430000, Hubei Province, China.
Center for Evidence-Based Medicine, Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China.
Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430000, Hubei Province, China.
Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China.


Proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H2RAs) are used for gastro-esophageal reflux disease (GERD); however, the clinical evidence for treatment is poor. We evaluated the effectiveness and tolerability of different doses of PPIs, H2RAs and placebo in adults with GERD. Six online databases were searched through September 1, 2016. All related articles were included and combined with a Bayesian network meta-analysis from randomized controlled trials (RCTs). The GRADE systems were employed to assess the main outcome. Ninety-eight RCTs were identified, which included 45,964 participants. Our analysis indicated that the full/standard dose of esomeprazole at 40 mg per day was the most efficient in healing among nine different dosages of PPIs and H2RAs. The main efficacy outcome did not change after adjustments for the area, age, level of disease from endoscopy, year of publication, pharmaceutical industry sponsorship, Intention-to-treat (ITT)/per-protocol (PP), withdrawal rate, pre-set select design bias, single blinded and unblinded studies, study origination in China, study arms that included zero events, inconsistency node or discontinued drug were accounted for in the meta-regressions and sensitivity analyses. This research suggests that the full/standard doses (40 mg per day) of esomeprazole should be recommended as first-line treatments for GERD in adults for short-term therapy.

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