Clinical-alimentary tractThe efficacy of proton pump inhibitors in nonulcer dyspepsia: A systematic review and economic analysis
Section snippets
Search strategy
Trials were identified from the Cochrane Controlled Trials Register (September 2002), MEDLINE (1966 to September 2002), EMBASE (1988 to September 2002), and CINAHL (1982 to September 2002), and the gray literature (eg, conference reports, technical reports, and dissertations) was searched using SIGLE. Details of the search strategy used for each database are published in the Cochrane Library.8 For example, for MEDLINE, patients with dyspepsia were identified with the medical subject heading and
PPI therapy versus placebo
A total of 11,796 citations were reviewed. Six eligible papers (reporting 8 trials)6, 7, 22, 23, 24, 25 were identified that compared PPI therapy with placebo in 3293 patients (Table 2). (For reference 22, data from the authors and TAP Pharmaceutical Products US were provided to separate trials M96 and M97.) Four papers (reporting 6 trials)6, 7, 22, 23 provided evaluable data to compare low- and standard-dose PPI therapy in 2032 patients. There was no statistically significant difference
Discussion
This is the first systematic review evaluating the efficacy of PPI therapy in NUD. We have shown that PPIs have a small but statistically significant effect on symptoms of NUD. This suggests that a modest proportion of patients with NUD have an acid-related disorder. There may be increased acid sensitivity in patients with NUD,28 because duodenal acidification has been shown to increase sensitivity to gastric distention.29 Studies have suggested, however, that peak and basal acid secretion in
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Appropriateness of proton pump inhibitors treatment in clinical practice: Prospective evaluation in outpatients and perspective assessment of drug optimisation
2020, Digestive and Liver DiseaseCitation Excerpt :Another finding of our study is that only a minority of patients, approximately 5% of the whole study population, were on long-term PPIs for dyspeptic symptoms, and this seems to positively underline the outreach of current recommendations in this setting [35–37]. However, on another note, the vast majority of them (i.e., 83.3%) was on continuous PPI treatment –with a median duration of 12 months– and had postprandial distress syndrome, a subset of functional dyspepsia where PPI administration has no role or may even be detrimental by inhibiting gastric motility, while another negative finding was that in none of these patients a step-down and withdrawal trial of the drug had previously been attempted [20,21,35–37]. In this cohort PPIs had been prescribed mainly by General Practitioners (63.1%), with only a minority of prescriptions originating from Gastroenterologists (18.4%) or other specialists (15.3%), while the proportion of patients taking PPIs following hospital discharge was negligible (3.2%).
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B.C.D. is supported by a UK National Health Service R&D Primary Care Career Scientist Award.