Proton-pump inhibitors have been proved as safe and effective ways to treat patients with non-erosive reflux disease

Proton-pump inhibitors (PPIs) have been proved as safe and effective ways to treat patients with non-erosive reflux disease (NERD). However, less is known about the comparisons among different PPIs and their best dosage.

Chen, L. et al published a studying Scientific Reports, to explore the efficacy and safety of PPIs in treating patients with non-erosive reflux disease that focused on the comparison among different PPIs and their best dosages. Gastro-oesophageal reflux disease (GORD) is a very common benign disease of the upper gastrointestinal tract.

The treatment of GORD has been revolutionised by the introduction, in the 1980s, of proton-pump inhibitors as the mainstay of medical therapy. PPIs have been proved as a safe and effective way to treat patients with GORD and are recommended as a main acid suppressive drug by many originations’ guidelines (e.g., the European Association of Endoscopic Surgery, the American College of Gastroenterology, the Indonesian Society of Gastroenterology and Pakistan Society of Gastroenterology). The reason that PPIs could relieve the symptoms is that the drug potently decreases gastric acid secretion by inhibiting the H ion – K ion adenosine triphosphatase pump of the parietal cell.

The meta-analysis conducted by Chen, L. et al focused on the comparison between different PPIs (omeprazole, rabeprazole and lansoprazole). Compared with control groups, all interventions except rabeprazole 5mg significantly increased rate of symptomatic relief. Among the comparisons of different PPIs, omeprazole 20mg group was associated with a higher rate of symptomatic relief in contrast to rabeprazole 5mg group or omeprazole 10mg group; dexlansoprazole 30mg therapy significantly improved the rate of symptomatic relief compared with rabeprazole 5mg group.

For the rate of adverse events, there was no significant difference among all interventions. According to overall rank results, omeprazole 20mg might be the best intervention in treating patients with non-erosive gastro-oesophageal reflux.

There was no significant difference among all interventions. No inconsistency was found through global and loop-specific approach. To test the robustness of the results, a meta-regression about mean age, percentage of male and duration of follow-up was performed. The results of meta-regressions showed they had no effect on the results of network meta-analyses.

Compared with control groups, all interventions, except rabeprazole 5mg, significantly increased rate of symptomatic relief. In addition, omeprazole 20mg group was associated with a higher rate of symptomatic relief in contrast to omeprazole 10mg group or rabeprazole 5mg group; dexlansoprazole 30mg therapy significantly improved the rate of symptomatic relief in contrast to rabeprazole 5mg group. For the rate of adverse events, there was no significant difference among all interventions.