Class 161st Year
Introdução à Medicina IFMUP
Is Esomeprazole the most efficient Proton Pump Inhibitor to relief symptoms and to induce mucosal healing, in patients with Gastroesophageal Reflux Disease ?
19th December 2007
Class 161st Year
Doutor Mário Dinis Ribeiro
Introdução à Medicina IFMUP
Ana LopesAndreia PintoCatarina MeloDiogo DiasIsabel SaavedraJoão MatiasMariana FerreiraMariana Mangas Paula Neves Rita Sapage Rui CoelhoTeresa Caridade Teresa Tavares
• Introduction to GERD• Research Question and Aim• Methods
• Study Design• Papers Selection:
• Queries• Number of Abstracts• Inclusion/Exclusion Criteria• Fluxogram
• Data to be extracted: • Variables• Quality assessment• Statistical treatment
Summary
Gastroesophageal Reflux Disease (GERD)• Prevalent and chronic condition
• Reflux of the stomach contents into the oesophagus
Troublesome symptoms- heartburn- acid regurgitation
Complications- haemorrhage, stricture, - Barrett’s oesophagus - adenocarcinoma of the distal
oesophagus
35% of Portuguese adults
refer GERD
symptoms
Adapted from: Maria João Branco, Paulo Nogueira, Teresa Contreiras. Uma observação sobre estimativas da prevalência de algumas
doenças crónicas, em Portugal Continental. Julho 2005, Observatório Nacional de Saúde, Instituto Dr. Ricardo Jorge.
• mainstay of medical therapy in GERD;• heals esophageal mucosal injury; • highly selective and effective in their action and have few short- or long-term adverse effects.
Omeprazole, Lanzoprazole Pantoprazole, Raberprazole
Proton Pump Inhibitors (PPIs)
Pettit M (2005). Treatment of gastroesophageal reflux disease. Pharm World Sci. 27 (6):432-5.
• New - generation PPI;
ESOMEprazole (40 mg)
• efficacy and safety were reviewed and causes of failure were discussed;
• Several studies have shown marginal differences in efficacy between various PPIs regimens.
Glatzel D et al (2006). Pantoprazole 40 mg is as effective as esomeprazole 40 mg to relieve symptoms of gastroesophageal reflux disease after 4 weeks of treatment and superior regarding the prevention of symptomatic relapse. Digestion. 74(3-4):145-54.
• Introduction to GERD• Research Question and Aim• Methods
• Study Design• Papers Selection:
• Queries• Number of Abstracts• Inclusion/Exclusion Criteria• Fluxogram
• Data to be extracted: • Variables• Quality assessment• Statistical treatment
Summary
Is esomeprazole more effective in enduring symptom relief and in healing
mucosal injury, relatively to omeprazole, lansoprazole, rabeprazole, pantoprazole,
in GERD patients?
Question of the study
Aim To compare efficacy of esomeprazole relatively to the other PPIs, in GERD patients, in
symptoms relief inducing mucosal healing
• Introduction to GERD• Research Question and Aim• Methods
• Study Design• Papers Selection:
• Queries• Number of Abstracts• Inclusion/Exclusion Criteria• Fluxogram
• Data to be extracted: • Variables• Quality assessment• Statistical treatment
Summary
Synthesis’ studies: Sistematic review Metanalysis
study
Bibliographic databases:• Medline (http://www.nlm.nih.gov/medlineplus/)• Scopus (http://www.scopus.com)• ISI Web of Knowledge
(http://isiwebofknowledge.com/)
Methods: Study design
• (gastroesophageal reflux OR "Gastroesophageal Reflux"[Mesh] OR GERD OR NERD OR non-esophagitis reflux disease OR esophagitis) AND (regurgitation OR heartburn) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract])) AND (omeprazole OR "Omeprazole"[Mesh] OR pantoprazole OR "pantoprazole"[Substance Name] OR rabeprazole OR "rabeprazole"[Substance Name] OR lansoprazole OR "lansoprazole"[Substance Name]) AND (esomeprazole OR "Omeprazole"[Mesh]) NOT (”Barrett esophagus” [Mesh])
158 articles
Methods: Paper Selection - Queries
- Pubmed -
• ((gastroesophageal reflux OR GERD OR NERD OR non-esophagitis reflux disease OR esophagitis)
AND (regurgitation OR heartburn)
AND (omeprazole OR pantoprazole OR rabeprazole OR lansoprazole) AND (esomeprazole) NOT (Barrett Syndrome))
35 articles
Methods: Paper Selection - Queries
- ISI Web of Knowledge -
• ((gastroesophageal reflux OR gerd OR nerd OR non-esophagitis reflux disease OR esophagitis)
AND (regurgitation OR heartbun) AND NOT (barrett syndrome))
AND (omeprazole OR pantoprazole OR rabeprazole OR lansoprazole) AND (esomeprazole)
AND (EXCLUDE(DOCTYPE, "re") OR EXCLUDE(DOCTYPE, "cp"))
57 articles
Methods: Paper Selection - Queries - Scopus -
ISI
PUBMED
SCOPUS12
7815
30
143
Methods: Paper Selection - Number of Abstracts
N=215
• Studies in Humans;• Studies in adults (19 - 75 years old);• Clinical trials; • Original articles; • Treatment of patients only with
PPIs;
Methods: Paper Selection - Inclusion criteria
• Inaccessibility of data;• Articles published from December
of 2007; • Studies in pregnant; • Studies in people with other
illnesses beyond GERD;
Methods: Paper Selection - Exclusion criteria
Paper Selection: FluxogramStart
Define a focused review
questionDefine a query
250 articles found
Run search on MedLine
35 articles excluded
Are the articles repeated?
No Yes
215 articles included
Do the two reviewers includ
the article?NoYes
100 articles included
Select articles according to inclusion and exclusion criteria
Do the two reviewers exclud
the article?
115 articles excluded
Yes
No The two reviewer
s discussEnd
• Data to collect:• number of participants; number of
participants who had abandoned the study• Intention to treat
• age and gender;• ethnia;• GERD (NERD vs Esophagitis)
• which PPI was esomeprazole compared against;
• dose of esomeprazole (20 or 40mg) and other;
Methods: Data to be Extracted - Variables
• time of intervention (in weeks)• time to outcome• primary aim (esomeprazole vs
other)• mucosal healing (assessment)• symptoms relief
• habits of the participants (ex. smoking)
• physiological state (ex. menopause)
Methods: Data to be Extracted - Variables
Methods: Data to be Extracted - Quality assessment
• CONSORT - Consolidated Standards of Reporting Trials
• QUOROM - Guidelines for Meta-Analyses and Systematic Reviews of RCTs
• SPSS and specific software for metanalysis (eg.: RevMan)
Methods: Data to be Extracted - Statistical treatment
• If Esomeprazole is:• more effective in symptom
relief;• healing and prevention of
mucosal injury;than old PPIs.
Outcome
Class 161st Year
Introdução à Medicina IFMUP
Feliz Natal!