Intervention Review

Additional bedtime H2-receptor antagonist for the control of nocturnal gastric acid breakthrough

  1. Yiping Wang1,*,
  2. Tao Pan2,
  3. Qiong Wang3,
  4. Zhen Guo1

Editorial Group: Cochrane Upper Gastrointestinal and Pancreatic Diseases Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 31 MAY 2009

DOI: 10.1002/14651858.CD004275.pub3

Database Title

Additional Information

How to Cite

Wang Y, Pan T, Wang Q, Guo Z. Additional bedtime H2-receptor antagonist for the control of nocturnal gastric acid breakthrough. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD004275. DOI: 10.1002/14651858.CD004275.pub3.

Author Information

  1. 1

    West China Hospital, Sichuan University, Department of Digestive Disease, Chengdu, Sichuan, China

  2. 2

    West China Hospital, Sichuan University, Department of Gastroenterology, Chengdu, Sichuan, China

  3. 3

    The Third People's Hospital, Department of Digestive Disease, Chengdu, Sichuan, China

*Yiping Wang, Department of Digestive Disease, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, China. wyiping2006@yahoo.com.cn. wyiping2002@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 7 OCT 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Nocturnal gastric acid breakthrough (NAB) is defined as intragastric pH<4 for more than one continuous hour overnight. Adding H2-receptor antagonists (H2RAs) at bedtime to high-dose proton pump inhibitors is likely to enhance nocturnal gastric pH control and decrease nocturnal gastric acid breakthrough.

Objectives

To assess the effectiveness of additional bedtime H2-receptor antagonists in suppressing nocturnal gastric acid breakthrough and the incidence of adverse effects.

Search methods

We identified eligible trials by searching The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2008), MEDLINE (1966-August 2008), EMBASE (1980-August 2008) and CINAHL (1982-August 2008). We re-ran the search on CENTRAL (The Cochrane Library Issue 4, 2008), and in MEDLINE, EMBASE and CINAHL in June 2004, July 2005, August 2006 and August 2008.

Selection criteria

All randomized controlled trials evaluating H2-receptor antagonists for the control of nocturnal gastric acid breakthrough were eligible for inclusion.

Data collection and analysis

Two reviewers have independently selected the trials to be included in the review according to the pre-stated eligibility criteria. Disagreements were resolved by a third reviewer. If the data could not be pooled for meta-analysis, a narrative description was provided.

Main results

8 small randomized controlled trials were included for meta-analysis. The results show that additional bedtime H2RAs can decrease the prevalence rate of nocturnal gastric acid breakthrough. The results of the analyses for secondary outcomes show that additional bedtime H2RAs can decrease the percentage of time during which pH is less than 4.0 inside the stomach and promote median intragastric pH.

Authors' conclusions

We can conclude no implications for practice at this stage. Appropriately designed large-scale randomized controlled trials with long-term follow-up are needed to determine the effects of additional bedtime H2RAs in suppressing nocturnal gastric acid breakthrough.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Additional bedtime medication for the control of night-time acid reflux from the stomach.

The inhibition of gastric acid secretion is an accepted treatment for diseases related to reflux of acid from the stomach. Some types of antacids, known as proton pump inhibitors (PPI), are considered to be the most effective medical treatment for people patients with acid-related diseases such as peptic ulcer, gastro-oesophageal reflux disease (GERD) and Zollinger-Ellison syndrome, but they may not reduce gastric acid secretion sufficiently to prevent night-time acid reflux symptoms. H2-receptor antagonists (H2RAs) have also been used for the treatment of acid-related diseases for more than a decade and might help to control night-time acid reflux, if taken at bedtime along with a high dose of PPI. The results show that additional bedtime H2RAs can decrease the night-time gastric acid breakthrough, but we believe that additional bedtime H2RAs to PPI should only be used as treatment an intervention in clinical trials until further evidence has been found.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

睡前額外添加H2受體拮抗劑來控制夜間胃酸分泌激增

夜間胃酸分泌激增的定義是夜間胃內pH值小於4連續至少一個小時。除了高劑量的質子泵抑製劑之外, 睡前額外添加H2受體拮抗劑有可能提高夜間胃pH值控制和減少夜間胃酸分泌激增。

目標

評估睡前額外添加H2受體拮抗劑抑制夜間胃酸分泌激增效果以及其副作用的發生率。

搜尋策略

我們尋找適當研究之方法為：搜尋Cochrane Central Register of Controlled Trials (CENTRAL)(Cochrane圖書館第3期， 2003年) ，MEDLINE(1966年至2003年7月) ，EMBASE(1980年至2003年7月)和CINAHL (1982年至2003年7月) 。我們於2004年6月， 2005年7月和2006年8月重新運行搜索CENTRAL(Cochrane圖書館2期， 2004年) ，並在MEDLINE, EMBASE，和CINAHL。

選擇標準

所有針對評估睡前額外添加H2RAs受體拮抗劑抑制夜間胃酸分泌激增效果的隨機對照試驗皆有資格列入本回顧。

資料收集與分析

我們本來打算分析這些結果的偏差，但納入之研究過少, 無法達成。

主要結論

兩個隨機交叉研究，其中包括32個參與者符合列入標準。由於這兩個研究之間的設計，劑量和治療時間不同，因此不能進行整合分析。這兩個研究, 評估睡前額外添加H2受體拮抗劑抑制夜間胃酸分泌激增效果, 沒有一致的結論。

作者結論

我們可以得出結論, 在現階段睡前額外添加H2H2受體拮抗劑抑制的做法並沒有影響。睡前額外添加H2受體拮抗劑是否能抑制夜間胃酸分泌激增, 仍須有適當設計並且長期追蹤的大型隨機對照試驗。

翻譯人

本摘要由臺中榮民總醫院周佳滿翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

睡前額外添加藥物用以控制夜間胃酸逆流。抑制胃酸分泌系一已被接受用來治療胃酸逆流相關疾病之方法。某些制酸劑，如質子泵抑制劑(PPI)則被認為是用於胃酸相關疾病病人，如消化性潰瘍、胃食道逆流和胃泌素瘤(ZE症侯群)最有效的內科治療方法，但是它們卻無法有效降低胃酸分泌來避免夜間胃酸逆流的症狀。H2受體拮抗劑(H2RAs)也已被用於治療胃酸相關疾病超過十年，且若睡前一併給予高劑量質子泵抑制劑有助於控制夜間胃酸逆流。結果顯示，睡前額外添加H2受體拮抗劑可減少夜間胃酸分泌激增，但我們相信除質子泵抑制劑(PPI)外，睡前額外添加H2受體拮抗劑(H2RAs)在更進一步實證資料發現之前，應只可用於臨床試驗中之介入治療法。

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