Table 29Treatment of GERD and its effect on asthma: Data from systematic reviews

Author YearGibson 200312
DesignA systematic review of GERD treatment for asthma in adults and children
PopulationPatients with asthma – adults (1 study of H2RA vs placebo included children and adolescents between 10-20 years of age).
Intervention (Exposure) and Comparator
  1. H2 antagonist - ranitidine and cimetidine
  2. Proton Pump Inhibitor (Only Omeprazole in varying doses - 20 mg, 40 mg, 80 mg and 160 mg
  3. Conservative anti-reflux therapy: raising the head of the bed, drinking warm water after meals, not eating for 3 hours prior to bed time, anti-reflux medication as required, avoid use of aspirin and anticholinergic preparations and avoidance of procedures increasing intra-abdominal pressure
  4. Surgery
Results
  • Database search yielded 262 abstracts, 22 full-text articles and 1 abstract were retrieved. Of these, 12 RCTs were included.
  • 9 cross-over trials and 3 parallel design, quality of studies (7 A studies, 4 B studies, and one C study), types of interventions: proton pump inhibitors (6 studies), histamine antagonists (5 studies), surgery (1 study), conservative management (1 study). With exception of 1 RCT comparing H2 antagonist with placebo who studied children and adolescents (aged 10-20 years old), all other RCTs investigated adults.
  • 9 of 12 studies failed to show a significant improvement in asthma symptoms.
  • Meta-analysis model and heterogeneity (if applicable):

    H2 antagonist, Proton Pump inhibitor, conservative or surgical therapy vs. placebo on FEV1: No effect of treatment

    H2 antagonist or Proton Pump inhibitor vs. placebo on morning peak expiratory flow, Fixed effect model, mean difference [95% CI]: 5.28 [-35.43, 44.72] Heterogeneity: Chi2 = 0.3, df=2 (P=0.86); I2=0.0%

    H2 antagonist or Proton Pump inhibitor vs. placebo on evening peak expiratory flow, Fixed effect model, mean difference [95% CI]: 7.03 [ -25.88, 39.95 ] Heterogeneity: Chi2 = 0.02, df=2 (P=0.99); I2=0.0%

    H2 antagonist vs. placebo on nocturnal symptoms score (including a study on adolescents), Fixed effect model, mean difference [95% CI]: -0.16 [ -0.42, 0.11 ] Heterogeneity: Chi2 = 0.97, df=3, (P=0.81); I2=0.0%

    Proton Pump inhibitor vs. placebo, Outcome: puffs per day, Fixed effect model, mean difference [95% CI]: -0.52 [-1.7, 0.67] Heterogeneity: Chi2 = 0.59, df=2, (P=0.74); I2=0.0%

CommentsThe duration of medical treatments was short in the most studies. Insufficient sample size in the pooled studies. One study included children and adolescents aged from 10 to 20 years.
AMSTAR
A priori design?YStudy quality assessment performed?Y
Two independent reviewers?YStudy quality appropriately used in analysis?N
Comprehensive literature search?YAppropriate statistical synthesis?Y
All publication types and languages included?YPublication bias assessed?N
Included and excluded studies listed?YConflicts of interest stated?Y
Study characteristics provided?Y
Author Year [PMID]Iqbal 2008113 [19105666]
DesignA systematic review of retrospective and prospective studies, including RCTs, of surgical fundoplication in the treatment of the symptoms of extraesophageal reflux (EER).
PopulationAdults
Intervention (Exposure) and ComparatorSurgery / fundoplication, vs. placebo/medical therapy
ResultsSeven studies, 350 patients – 1 RCT, four prospective studies, 2 retrospective studies;
In 3 out of 7 studies, 0 to 64 percent of the participants reported a complete resolution of asthma symptoms. In 6 studies, 15 to 84 percent of the participants reported a partial resolution of asthma symptoms after surgery.
CommentsIncluded both prospective and retrospective studies; only 1 RCT for asthma; no quantitative analysis; quality of studies was not assessed
AMSTAR
A priori design?NStudy quality assessment performed?N
Two independent reviewers?NStudy quality appropriately used in analysis?n/a
Comprehensive literature search?YAppropriate statistical synthesis?n/a
All publication types and languages included?NPublication bias assessed?N
Included and excluded studies listed?NConflicts of interest stated?Y
Study characteristics provided?Y

From: Results

Cover of Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease: Update
Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease: Update [Internet].
Comparative Effectiveness Reviews, No. 29.
Ip S, Chung M, Moorthy D, et al.

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