Systematic review: Antacids, H2-receptor antagonists, prokinetics, bismuth and sucralfate therapy for non-ulcer dyspepsia.
BACKGROUND
Evidence for the effectiveness of antacids, histamine-2 receptor antagonists, bismuth salts, sucralfate and prokinetic therapy in non-ulcer dyspepsia is conflicting.


OBJECTIVE
To conduct a systematic review evaluating these therapies in non-ulcer dyspepsia.


METHODS
Electronic searches were performed using the Cochrane Controlled Trials Register, Medline, EMBASE, Cinahl and SIGLE until September 2002. Dyspepsia outcomes were dichotomized into cured/improved vs. same/worse.


RESULTS
Prokinetics [14 trials, 1053 patients; relative risk reduction (RRR), 48%; 95% confidence interval (95% CI), 27-63%] and histamine-2 receptor antagonists (11 trials, 2164 patients; RRR, 22%; 95% CI, 7-35%) were significantly more effective than placebo. Bismuth salts (RRR, 40%; 95% CI, - 3% to 65%) were superior to placebo, but this was of marginal statistical significance. Antacids and sucralfate were not statistically significantly superior to placebo. A funnel plot suggested that the prokinetic and histamine-2 receptor antagonist results could be due to publication bias.


CONCLUSIONS
The meta-analyses suggest that histamine-2 receptor antagonists and prokinetics are superior to placebo. These data are difficult to interpret, however, as funnel plot asymmetry suggests that the magnitude of the effect could be due to publication bias or other heterogeneity-related issues.
Moayyedi
P
P
Gastroenterology Unit, City Hospital NHS Trust, Birmingham, UK. p.moayyedi@bham.ac.uk
Soo
S
S
Deeks
J
J
Forman
D
D
Harris
A
A
Innes
M
M
Delaney
B
B
D000284:Administration, Oral; D000863:Antacids / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use; D020117:Cisapride / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005772:Gastrointestinal Transit / Q000187:drug effects; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D013392:Sucralfate / Q000627:therapeutic use; D016896:Treatment Outcome
D000863:Antacids; D005765:Gastrointestinal Agents; D006635:Histamine H2 Antagonists; D013392:Sucralfate; D001729:Bismuth; D020117:Cisapride