Hydrotalcite in the treatment of reflux esophagitis: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

DU Xuanling ^1,2 , XU Qiping ³ , PAN Duyi ^1,2 , ZHOU Ji ^1,2 ,  CHEN Shiyao ^1,2,3

1. Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, 200032, P.R.China;
2. Center of Evidence-Based Medicine, Fudan University, Shanghai, 200032, P.R.China;
3. School of Clinical Medicine, Fudan University, Shanghai, 200032, P.R.China;

Corresponding?author：

CHEN Shiyao, Email: chen.shiyao@zs-hospital.sh.cn

Keywords：

Gastroesophageal reflux disease; Reflux esophagitis; Hydrotalcite; Proton pump inhibitors; Meta-analysis; Systematic review; Randomized clinical trial

DOI：

10.7507/1672-2531.201805111

Video：

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ObjectivesTo systematically review the efficacy and safety of hydrotalcite in the treatment of reflux esophagitis (RE).MethodsCBM, CNKI, WanFang Data, VIP, PubMed, EMbase, The Cochrane Library, Web of Science and Scopus databases were searched online to collect randomized clinical trials (RCTs) of hydrotalcite or hydrotalcite plus PPI versus PPI alone in the treatment of RE from inception to June 30^th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 15 RCTs involving 1 655 patients were included. The results of meta-analysis showed that: after 4-8 weeks of treatment, there was no significant difference between hydrotalcite vs. PPI regarding RE healing rates (RR=0.87, 95%CI 0.76 to 1.00, P=0.05). However, there were significant increases in RE healing rate (RR=1.22, 95%CI 1.14 to 1.31, P<0.001) and symptom relief rate (RR=1.36, 95%CI 1.12 to 1.66,P<0.01) between hydrotalcite plus PPIvs. PPI alone. Similar increases of RE healing rate (RR=1.16, 95%CI 1.08 to 1.25, P<0.001) and symptom relief rate (RR=1.12, 95%CI 1.04 to 1.20,P<0.01) were seen in patients with refractory RE. No increase of adverse effect rate was shown with hydrotalcite or hydrotalcite plus PPI compared to PPI alone.ConclusionsCompared with PPI alone, hydrotalcite plus PPI confers a statistically significant improvement of healing rate and symptom relief rate, while it does not increase adverse effect rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： DU Xuanling, XU Qiping, PAN Duyi, ZHOU Ji, CHEN Shiyao. Hydrotalcite in the treatment of reflux esophagitis: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(9): 924-930. doi: 10.7507/1672-2531.201805111 Copy

1.	陳旻湖, 侯曉華, 肖英蓮, 等. 2014年中國胃食管反流病專家共識意見. 胃腸病學, 2015, 20(3): 155-168.
2.	DeVault KR, Castell DO, American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol, 2005, 100(1): 190-200.
3.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011. Available at: http://handbook.cochrane.org.
4.	鋁碳酸鎂多中心臨床協作組. 鋁碳酸鎂治療反流性食管炎的多中心臨床觀察. 中華內科雜志, 2001, 40(12): 819-822.
5.	鄧盈軍, 徐華, 王彩云, 等. 鋁碳酸鎂治療反流性食道炎的近期臨床療效觀察. 國際醫藥衛生導報, 2006, 12(16): 83-85.
6.	王戰波, 陳玲玲, 游旭東. 聯合應用埃索美拉唑、鋁碳酸鎂和莫沙比利治療難治性胃食管反流病. 世界華人消化雜志, 2007, 15(8): 901-904.
7.	金錦蓮, 譚成偉, 胡利兵. 雷貝拉唑聯合鋁碳酸鎂治療反流性食管炎 30 例療效觀察. 新醫學, 2007, 38(1): 24-25.
8.	周家華. 三聯療法治療胃食管反流病的臨床療效. 上海醫學, 2008, 31(12): 886-887.
9.	方翰良, 方奇慧. 聯合應用雷貝拉唑、鋁碳酸鎂和莫沙比利治療難治性胃食管反流病 202 例療效觀察. 臨床消化病雜志, 2009, 21(1): 49-51.
10.	許雪全, 王顯飛. 奧美拉唑聯合莫沙比利、鋁碳酸鎂治療胃食管反流病療效觀察. 中國實用醫刊, 2011, 38(2): 115-116.
11.	滕景俠. 奧美拉唑聯合莫沙比利、鋁碳酸鎂治療胃食管反流病的臨床研究. 中國當代醫藥, 2012, 19(15): 50-51.
12.	馮建東. 泮托拉唑聯合鋁碳酸鎂治療胃食管反流病臨床療效觀察. 中國醫藥導刊, 2013, 15(2): 283-284.
13.	陳龍, 陳福敏, 杜宗漢, 等. 埃索美拉唑聯合莫沙必利、鋁碳酸鎂治療難治性胃食管反流病的臨床觀察. 胃腸病學和肝病學雜志, 2013, 22(1): 57-59.
14.	姜齊宏, 陳艷, 王愛祥, 等. 鋁碳酸鎂片聯合埃索美拉唑、黛力新治療胃食管反流病 60 例. 世界華人消化雜志, 2013, 21(23): 2331-2334.
15.	禹曉娟. 鋁碳酸鎂與泮托拉唑在反流性食管炎治療中的作用比較研究. 衡陽: 南華大學, 2014.
16.	董道文. 埃索美拉唑聯合鋁碳酸鎂片和黛力新治療胃食管反流病 70 例. 中國藥業, 2014, 23(17): 90-91.
17.	李志明. 鋁碳酸鎂與泮托拉唑治療反流性食管炎的療效比較. 北方藥學, 2016, 13(12): 94-95.
18.	徐柏興, 李佳. 不同方法治療難治性胃食管反流病的療效觀察. 中國實用醫藥, 2017, 12(7): 4-6.
19.	Ma XQ, Cao Y, Wang R, et al. Prevalence of, and factors associated with, gastroesophageal reflux disease: a population-based study in Shanghai, China. Dis Esophagus, 2009, 22(4): 317-322.
20.	Fock KM, Talley N, Goh KL, et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus. Gut, 2016, 65(9): 1402-1415.
21.	Tan VP, Wong BC, Wong WM, et al. Gastroesophageal reflux disease: cross-sectional study demonstrating rising prevalence in a Chinese population. J Clin Gastroenterol, 2016, 50(1): e1-e7.
22.	Vakil N, van Zanten S V, Kahrilas P, et al. The Montreal definition and classification of gastro esophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol, 2006, 101(8): 1900-1920.
23.	Bredenoord AJ. Mechanisms of reflux perception in gastroesophageal reflux disease: a review. Am J Gastroenterol, 2012, 107(1): 8-15.
24.	Hunt R, Armstrong D, Katelaris P, et al. World gastroenterology organisation global guidelines: GERD global perspective on gastroesophageal reflux disease. J Clin Gastroenterol, 2017, 51(6): 467-478.
25.	Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol, 2013, 108(3): 308-328.
26.	Mendelsohn D, Mendelsohn L. Hydrogen ion, pepsin and bile acid binding properties of hydrotalcite. S Afr Med J, 1975, 49(25): 1011-1014.
27.	Xu XR, Li ZS, Zou DW, et al. Role of duodenogastroesophageal reflux in the pathogenesis of esophageal mucosal injury and gastroesophageal reflux symptoms. Can J Gastroenterol, 2006, 20(2): 91-94.
28.	Tack J, Koek G, Demedts I, et al. Gastroesophageal reflux disease poorly responsive to single-dose proton pump inhibitors in patients without Barrett's esophagus: acid reflux, bile reflux, or both? Am J Gastroenterol, 2004, 99(6): 981-988.
29.	Schweitzer EJ, Bass BL, Batzri S, et al. Bile acid accumulation by rabbit esophageal mucosa. Dig Dis Sci, 1986, 31(10): 1105-1113.
30.	Tarnawski AS, Tomikawa M, Ohta M, et al. Antacid talcid activates in gastric mucosa genes encoding for EGF and its receptor. The molecular basis for its ulcer healing action. J Physiol Paris, 2000, 94(2): 93-98.
31.	Holtmeier W, Holtmann G, Caspary WF, et al. On-demand treatment of acute heartburn with the antacid hydrotalcite compared with famotidine and placebo: randomized double-blind cross-over study. J Clin Gastroenterol, 2007, 41(6): 564-570.
32.	Konturek JW, Beneke M, Koppermann R, et al. The efficacy of hydrotalcite compared with OTC famotidine in the on-demand treatment of gastroesophageal reflux disease: a non-inferiority trial. Med Sci Monit, 2007, 13(1): C44-C49.
33.	Xiao YL, Nie YQ, Hou XH, et al. The efficacy, safety and cost-effectiveness of hydrotalcite versus esomeprazole in on-demand therapy of NERD: A multicenter, randomized, open-label study in China. J Dig Dis, 2013, 14(9): 463-468.

1. 陳旻湖, 侯曉華, 肖英蓮, 等. 2014年中國胃食管反流病專家共識意見. 胃腸病學, 2015, 20(3): 155-168.
2. DeVault KR, Castell DO, American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol, 2005, 100(1): 190-200.
3. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011. Available at: http://handbook.cochrane.org.
4. 鋁碳酸鎂多中心臨床協作組. 鋁碳酸鎂治療反流性食管炎的多中心臨床觀察. 中華內科雜志, 2001, 40(12): 819-822.
5. 鄧盈軍, 徐華, 王彩云, 等. 鋁碳酸鎂治療反流性食道炎的近期臨床療效觀察. 國際醫藥衛生導報, 2006, 12(16): 83-85.
6. 王戰波, 陳玲玲, 游旭東. 聯合應用埃索美拉唑、鋁碳酸鎂和莫沙比利治療難治性胃食管反流病. 世界華人消化雜志, 2007, 15(8): 901-904.
7. 金錦蓮, 譚成偉, 胡利兵. 雷貝拉唑聯合鋁碳酸鎂治療反流性食管炎 30 例療效觀察. 新醫學, 2007, 38(1): 24-25.
8. 周家華. 三聯療法治療胃食管反流病的臨床療效. 上海醫學, 2008, 31(12): 886-887.
9. 方翰良, 方奇慧. 聯合應用雷貝拉唑、鋁碳酸鎂和莫沙比利治療難治性胃食管反流病 202 例療效觀察. 臨床消化病雜志, 2009, 21(1): 49-51.
10. 許雪全, 王顯飛. 奧美拉唑聯合莫沙比利、鋁碳酸鎂治療胃食管反流病療效觀察. 中國實用醫刊, 2011, 38(2): 115-116.
11. 滕景俠. 奧美拉唑聯合莫沙比利、鋁碳酸鎂治療胃食管反流病的臨床研究. 中國當代醫藥, 2012, 19(15): 50-51.
12. 馮建東. 泮托拉唑聯合鋁碳酸鎂治療胃食管反流病臨床療效觀察. 中國醫藥導刊, 2013, 15(2): 283-284.
13. 陳龍, 陳福敏, 杜宗漢, 等. 埃索美拉唑聯合莫沙必利、鋁碳酸鎂治療難治性胃食管反流病的臨床觀察. 胃腸病學和肝病學雜志, 2013, 22(1): 57-59.
14. 姜齊宏, 陳艷, 王愛祥, 等. 鋁碳酸鎂片聯合埃索美拉唑、黛力新治療胃食管反流病 60 例. 世界華人消化雜志, 2013, 21(23): 2331-2334.
15. 禹曉娟. 鋁碳酸鎂與泮托拉唑在反流性食管炎治療中的作用比較研究. 衡陽: 南華大學, 2014.
16. 董道文. 埃索美拉唑聯合鋁碳酸鎂片和黛力新治療胃食管反流病 70 例. 中國藥業, 2014, 23(17): 90-91.
17. 李志明. 鋁碳酸鎂與泮托拉唑治療反流性食管炎的療效比較. 北方藥學, 2016, 13(12): 94-95.
18. 徐柏興, 李佳. 不同方法治療難治性胃食管反流病的療效觀察. 中國實用醫藥, 2017, 12(7): 4-6.
19. Ma XQ, Cao Y, Wang R, et al. Prevalence of, and factors associated with, gastroesophageal reflux disease: a population-based study in Shanghai, China. Dis Esophagus, 2009, 22(4): 317-322.
20. Fock KM, Talley N, Goh KL, et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus. Gut, 2016, 65(9): 1402-1415.
21. Tan VP, Wong BC, Wong WM, et al. Gastroesophageal reflux disease: cross-sectional study demonstrating rising prevalence in a Chinese population. J Clin Gastroenterol, 2016, 50(1): e1-e7.
22. Vakil N, van Zanten S V, Kahrilas P, et al. The Montreal definition and classification of gastro esophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol, 2006, 101(8): 1900-1920.
23. Bredenoord AJ. Mechanisms of reflux perception in gastroesophageal reflux disease: a review. Am J Gastroenterol, 2012, 107(1): 8-15.
24. Hunt R, Armstrong D, Katelaris P, et al. World gastroenterology organisation global guidelines: GERD global perspective on gastroesophageal reflux disease. J Clin Gastroenterol, 2017, 51(6): 467-478.
25. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol, 2013, 108(3): 308-328.
26. Mendelsohn D, Mendelsohn L. Hydrogen ion, pepsin and bile acid binding properties of hydrotalcite. S Afr Med J, 1975, 49(25): 1011-1014.
27. Xu XR, Li ZS, Zou DW, et al. Role of duodenogastroesophageal reflux in the pathogenesis of esophageal mucosal injury and gastroesophageal reflux symptoms. Can J Gastroenterol, 2006, 20(2): 91-94.
28. Tack J, Koek G, Demedts I, et al. Gastroesophageal reflux disease poorly responsive to single-dose proton pump inhibitors in patients without Barrett's esophagus: acid reflux, bile reflux, or both? Am J Gastroenterol, 2004, 99(6): 981-988.
29. Schweitzer EJ, Bass BL, Batzri S, et al. Bile acid accumulation by rabbit esophageal mucosa. Dig Dis Sci, 1986, 31(10): 1105-1113.
30. Tarnawski AS, Tomikawa M, Ohta M, et al. Antacid talcid activates in gastric mucosa genes encoding for EGF and its receptor. The molecular basis for its ulcer healing action. J Physiol Paris, 2000, 94(2): 93-98.
31. Holtmeier W, Holtmann G, Caspary WF, et al. On-demand treatment of acute heartburn with the antacid hydrotalcite compared with famotidine and placebo: randomized double-blind cross-over study. J Clin Gastroenterol, 2007, 41(6): 564-570.
32. Konturek JW, Beneke M, Koppermann R, et al. The efficacy of hydrotalcite compared with OTC famotidine in the on-demand treatment of gastroesophageal reflux disease: a non-inferiority trial. Med Sci Monit, 2007, 13(1): C44-C49.
33. Xiao YL, Nie YQ, Hou XH, et al. The efficacy, safety and cost-effectiveness of hydrotalcite versus esomeprazole in on-demand therapy of NERD: A multicenter, randomized, open-label study in China. J Dig Dis, 2013, 14(9): 463-468.

Chinese Journal of Evidence-Based Medicine

Hydrotalcite in the treatment of reflux esophagitis: a meta-analysis

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