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

  • Review
  • Intervention

Authors


Abstract

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.

アブストラクト

nocturnal gastric acid breakthrough(夜間胃酸急増)コントロールのためのH2受容体拮抗薬の就寝時追加

背景

nocturnal gastric acid breakthrough(夜間胃酸急増[NAB])は、夜間に1時間以上連続して胃内pHが4未満になる場合と定義されている。高用量プロトンポンプ阻害薬にH2受容体拮抗薬(H2RA)を就寝時に追加することにより夜間の胃内pHコントロールが上昇し、NABが軽減される可能性がある。

目的

NABを抑え有害作用の罹患率を抑制するために、就寝時に追加するH2受容体拮抗薬の有効性を評価する。

検索戦略

Cochrane Central Register of Controlled Trials(CENTRAL)(コクラン・ライブラリ2008年第4号)、MEDLINE(1966年~2008年8月)、EMBASE(1980年~2008年8月)およびCINAHL(1982年~2008年8月)を検索して適格な試験を同定した。再度CENTRAL(コクラン・ライブラリ2008年第4号)ならびに2004年6月、2005年7月、および2008年8月にMEDLINE、EMBASEおよびCINAHLを検索した。

選択基準

NABコントロールのためにH2受容体拮抗薬を評価したすべてのランダム化比較試験を選択に適格とした。

データ収集と分析

2名のレビューアが先に述べた適格性基準に従って、本レビューに含める試験を独自に選択した。不一致は第3のレビューアにより解決した。メタアナリシスのためのデータを統合できない場合は、叙述的な記述を示した。

主な結果

8件の小規模なランダム化比較試験をメタアナリシスに含めた。結果から、就寝時H2RAの追加はNABの発生率を低下させることが示された。副次的アウトカムの解析結果から、就寝時H2RAの追加は胃内pHが4.0未満となる時間の割合を低下させ、胃内pHの中央値を上昇させることが示された。

著者の結論

現段階では診療での意義については何ら結論付けることはできない。NABの抑える上での就寝時H2RAの追加効果を明らかにするために、適切にデザインされ、長期的な追跡を伴う大規模なランダム化比較試験が必要である。

訳注

Translated by: MINDS

Translation supported by:

Plain language summary

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.