Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: a meta-analysis.
OBJECTIVE
To systematically evaluate the efficacy of H(2)-receptor antagonists (H(2)RAs) and proton pump inhibitors in healing erosive esophagitis (EE).


METHODS
A meta-analysis was performed. A literature search was conducted in PubMed, Medline, Embase, and Cochrane databases to include randomized controlled head-to-head comparative trials evaluating the efficacy of H(2)RAs or proton pump inhibitors in healing EE. Relative risk (RR) and 95% confidence interval (CI) were calculated under a random-effects model.


RESULTS
RRs of cumulative healing rates for each comparison at 8 wk were: high dose vs standard dose H(2)RAs, 1.17 (95%CI, 1.02-1.33); standard dose proton pump inhibitors vs standard dose H(2)RAs, 1.59 (95%CI, 1.44-1.75); standard dose other proton pump inhibitors vs standard dose omeprazole, 1.06 (95%CI, 0.98-1.06). Proton pump inhibitors produced consistently greater healing rates than H(2)RAs of all doses across all grades of esophagitis, including patients refractory to H(2)RAs. Healing rates achieved with standard dose omeprazole were similar to those with other proton pump inhibitors in all grades of esophagitis.


CONCLUSIONS
H(2)RAs are less effective for treating patients with erosive esophagitis, especially in those with severe forms of esophagitis. Standard dose proton pump inhibitors are significantly more effective than H(2)RAs in healing esophagitis of all grades. Proton pump inhibitors given at the recommended dose are equally effective for healing esophagitis.
Wang
Wei-Hong
WH
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Huang
Jia-Qing
JQ
Zheng
Ge-Fan
GF
Xia
Harry Hua-Xiang
HH
Wong
Wai-Man
WM
Lam
Shiu-Kum
SK
Wong
Benjamin Chun-Yu
BC
D004941:Esophagitis / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D009853:Omeprazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D016032:Randomized Controlled Trials as Topic; D014945:Wound Healing / Q000187:drug effects
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D009853:Omeprazole