Treatment of non-ulcer dyspepsia: a meta-analysis of placebo-controlled prospective studies.
BACKGROUND
Dyspeptic symptoms are commonly reported complaints in clinical practice and are mostly the result of functional disorders. Empirical treatment with histamine H2-receptor blockers or gastroprokinetics for 2-4 weeks has frequently been proposed as first line management of these patients. The clinical trials which support the use of these agents, show a high variation in clinical success rate and benefit of these treatments.


METHODS
The available clinical trials were evaluated, pooled where appropriate and subjected to a meta-analysis with the principal goal to provide valid treatment recommendations for patients with non-ulcer dyspepsia. In the present meta-analysis 19 studies on gastroprokinetics (cisapride, domperidone) and 10 studies on histamine H2-receptor antagonists (cimetidine, ranitidine) were included.


RESULTS
Based on these studies, a total of 1540 patients were evaluated for histamine H2-receptor antagonists (verum n = 786, placebo n = 754) and 1235 patients for gastroprokinetics (verum n = 616, placebo n = 619). The probability for treatment success compared to placebo was 0.2026 (0.1261; 0.2791) for histamine H2-receptor antagonists and 0.4029 (0.3042; 0.5069) for gastroprokinetics.


CONCLUSIONS
Based on these data both treatments are significantly more effective than placebo in the symptomatic treatment of non-ulcer dyspepsia, with gastroprokinetics (cisapride, domperidone) being more effective than histamine H2-receptor antagonists (cimetidine, ranitidine).
Allescher
H D
HD
II. Medizinische Klinik und Poliklinik, Technischen Universität München, Germany. hans.allescher@lrz.tum.de
Böckenhoff
A
A
Knapp
G
G
Wienbeck
M
M
Hartung
J
J
D002927:Cimetidine / Q000627:therapeutic use; D020117:Cisapride / Q000627:therapeutic use; D004294:Domperidone / Q000627:therapeutic use; D004415:Dyspepsia / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D011899:Ranitidine / Q000627:therapeutic use; D012107:Research Design
D005765:Gastrointestinal Agents; D006635:Histamine H2 Antagonists; D004294:Domperidone; D002927:Cimetidine; D011899:Ranitidine; D020117:Cisapride