Early heartburn relief with proton pump inhibitors: a systematic review and meta-analysis of clinical trials.
OBJECTIVE
Proton pump inhibitors (PPIs) are often taken for short-term treatment of heartburn. We performed a systematic review of the efficacy of PPIs for heartburn relief within the first 1-2 days of therapy.


METHODS
Bibliographic databases were searched for clinical trials of PPIs in patients with heartburn that provided information about the proportion with heartburn relief at day 1-2. The sample size-weighted pooled proportions of patients with complete or sustained (7 consecutive days) relief were calculated. Meta-analyses of randomized comparisons of PPIs were also performed.


RESULTS
Eighteen trials met inclusion criteria. At day 1 of PPI therapy, complete 24-hour, daytime, nighttime, and sustained heartburn relief occurred in 0.31 (95% confidence interval [CI], 0.30-0.32), 0.49 (95% CI, 0.48-0.50), 0.55 (95% CI, 0.53-0.56), and 0.21 (95% CI, 0.20-0.22) of patients. Up to 37% of the heartburn relief achievable with 28 days of PPIs occurred on day 1. Placebo was significantly less effective than PPIs for 24-hour relief on day 1 (relative risk [RR], 0.41; 95% CI, 0.29-0.58), and single-dose PPI therapy was less effective than double-dose therapy (RR, 0.82; 95% CI, 0.74-0.92).


CONCLUSIONS
Complete heartburn relief for the entire day occurs in approximately 30% of patients after their first PPI dose and 9% of patients after their first placebo (RR for relief on day 1 for placebo versus PPI was 0.41 [95% CI, 0.28-0.58]). Although PPIs might provide benefit from the first day of therapy, most patients will not have symptom relief with 1 or 2 days of PPI therapy.
McQuaid
Kenneth R
KR
Department of Medicine, University of California San Fransisco, CA, USA. Kenneth.mcquaid@med.va.gov
Laine
Loren
L
D002986:Clinical Trials as Topic; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D006356:Heartburn / Q000188:drug therapy* / Q000201:enzymology; D006801:Humans; D054328:Proton Pump Inhibitors; D016896:Treatment Outcome
D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors