Evidence-Based Treatment for First-visit Gastro-esophageal Reflux Disease_Chinese Journal of Evidence-Based Medicine

Authors：

JI Mengyao ,  DONG Weiguo , LV Xiaoguang , WU Na , PENG Xiulan

Department of Gastroenterology, Wuhan University People’s Hospital, Wuhan 430060, China;

Corresponding author：

DONG Weiguo, Email: dongwg66@yahoo.com.cn

Keywords：

Gastro-esophageal reflux disease; Proton pump inhibitors; Helicobacter pylori infection; Anti-infection treatment against Helicobacter pylori; Evidence-based treatment

DOI：

10.7507/1672-2531.20110081

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To make an individualized treatment plan for one first-visit gastro-esophageal reflux disease patient via evidence-based medicine methods.
Methods 　The condition of the patient was evaluated comprehensively, then clinical problems were put forward according to PICO principle, and high-quality evidence was collected from The Cochrane Library (1990 to 2010), PubMed (1990 to 2010), and EMbase (1990 to 2010). The treatment plan was designed based on the evaluation of evidence, doctor’s experience, and patient’s preferences.
Results 　A total of 17 RCTs and 10 meta-analyses/ systematic reviews were included. The evidence showed that the therapeutic effect of PPI was better than that of H2RA, and meanwhile prokinetic drugs should be used. When PPI needed to be use for a long time, HP eradication operation was required for the combination of HP inflammation. Laparoscopic fundoplication surgery was a better choice if the operation was required. Based on the above evidence combined with the patient’s preferences, the combination of general treatment, esomeprazole and cisaPride were adopted to treat. Meanwhile, anti-HP medicine was used to control the HP inflammation caused by the long-term maintenance therapy. The gastro-esophageal reflux symptoms were remarkably relieved six months after the treatment.
Conclusion 　PPI plus prokinetic drugs, combined with HP eradication of gastroesophageal reflux surgery, can improve the clinical outcomes and patient’s quality of life. However, long-term prognostic benefits need to be confirmed by further follow-up.

Citation： JI Mengyao,DONG Weiguo,LV Xiaoguang,WU Na,PENG Xiulan. Evidence-Based Treatment for First-visit Gastro-esophageal Reflux Disease. Chinese Journal of Evidence-Based Medicine, 2011, 11(4): 468-472. doi: 10.7507/1672-2531.20110081 Copy

1.	2 Corley DA, Kubo A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol , 2006, 101(11): 2619-2628.
2.	中华医学会消化内镜学分会. 反流性食管炎诊断及治疗指南（2003）. 中华消化内镜杂志, 2004, 21(4): 221-222.
3.	El-Serag H. The association between obesity and GERD: a review of the epidemiological evidence. Dig Dis Sci , 2008, 53(9): 2307-2312.
4.	Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med , 2005, 143(3): 199-211.
5.	Piesman M, Hwang I, Maydonovitch C, et al . Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? Am J Gastroenterol , 2007, 102(10): 2128-2134.
6.	DiBaise JK. A randomized, double-blind comparison of two different coffee-roasting processes on development of heartburn and dyspepsia in coffee-sensitive individuals. Dig Dis Sci , 2003, 48(4): 652-656.
7.	Cook MB, Kamangar F, Whiteman DC, et al . Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium. J Natl Cancer Inst , 2010, 102(17): 1344-1353.
8.	Edelstein ZR, Bronner MP, Rosen SN, et al . Risk factors for Barrett's esophagus among patients with gastroesophageal reflux disease: a community clinic-based case-control study. Am J Gastroenterol , 2009, 104(4): 834-842.
9.	Pehl C, Wendl B, Pfeiffer A. White wine and beer induce gastro-oesophageal reflux in patients with reflux disease. Aliment Pharmacol Ther , 2006, 23(11): 1581-1586.
10.	Colombo P, Mangano M, Bianchi PA, et al . Effect of calories and fat on postprandial gastro-oesophageal reflux. Scand J Gastroenterol, 2002, 37(1): 3-5.
11.	Galmiche JP, Fraitag B, Filoche B, et al . Double-blind comparison of cisapride and cimetidine in treatment of reflux esophagitis. Dig Dis Sci , 1990, 35(5): 649-655.
12.	Khan M, Santana J, Donnellan C, et al . Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev , 2007, 18(2): CD003244.
13.	van Pinxteren B, Numans ME, Bonis PA, et al . Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev , 2006, 19(3): CD002095.
14.	Cutler A, Robinson M, Murthy A, et al . Rabeprazole 20 mg for erosive esophagitis-associated symptoms in a large, community-based study: additional results. Dig Dis Sci , 2010, 55(2): 338-345.
15.	Pace F, Annese V, Prada A, et al . Rabeprazole is equivalent to omeprazole in the treatment of erosive gastro-oesophageal reflux disease. A randomised, double-blind, comparative study of rabeprazole and omeprazole 20 mg in acute treatment of reflux oesophagitis, followed by a maintenance open-label, low-dose therapy with rabeprazole. Dig Liver Dis, 2005, 37(10): 741-750.
16.	Edwards SJ, Lind T, Lundell L. Systematic review: proton pump inhibitors (PPIs) for the healing of reflux oesophagitis - a comparison of esomeprazole with other PPIs. Aliment Pharmacol Ther , 2006, 24(5): 743-750.
17.	钟捷译. 埃索美拉唑与奥美拉唑对胃食管反流病24小时胃内PH效果比较. 中华消化杂志, 2003, 23(8): 391-492.
18.	Kiljander TO, Junghard O, Beckman O, et al . Effect of esomeprazole 40 mg once or twice daily on asthma: a randomized, placebo-controlled study. Am J Respir Crit Care Med , 2010, 181(10):1042-1048.
19.	Wu JC, Chan FK, Ching JY, et al . Effect of Helicobacter pylori eradication on treatment of gastro-esophageal reflux disease: a double blind, placebo controlled, randomized trial. Gut , 2004, 53(2):174-179.
20.	Giannini EG, Zentilin P, Dulbecco P, et al . Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. Am J Gastroenterol , 2008, 103(2): 267-275.
21.	Goh KL, Benamouzig R, Sander P, Efficacy of pantoprazole 20 mg daily compared with esomeprazole 20 mg daily in the maintenance of healed gastroesophageal reflux disease: a randomized, double-blind comparative trial - the EMANCIPATE study. Eur J Gastroenterol Hepatol , 2007, 19(3): 205-211.
22.	Toussaint J, Gossuin A, Deruyttere M. Healing and prevention of relapse of reflux oesophagitis by cisapride. Gut , 1991, 32(11): 1280-1285.
23.	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.
24.	Yaghoobi M, Farrokhyar F, Yuan Y, et al . Is there an increased risk of GERD after Helicobacter pylori eradication?: a meta-analysis. Am J Gastroenterol , 2010, 105(5): 1007-1013.
25.	Schröder S, van Hülst S, Raabe W, et al . Nasojejunal enteral feeding tubes in critically ill patients. Successful placement without technical assistance. Anaesthesist , 2007, 56(12): 1217-1222.
26.	Aziz AM, El-Khayat HR, Sadek A, et al . A prospective randomized trial of sham, single-dose Stretta, and double-dose Stretta for the treatment of gastroesophageal reflux disease. Surg Endosc , 2010, 24(4): 818-825.
27.	Meneghelli UG, Boaventura S, Moraes-Filho JP, et al . Efficacy and tolerability of pantoprazole versus ranitidine in the treatment of reflux esophagitis and the influence of Helicobacter pylori infection on healing rate. Dis Esophagus , 2002, 15(1): 50-56.
28.	Salminen PT, Hiekkanen HI, Rantala AP, et al . Comparison of long-term outcome of laparoscopic and conventional nissen fundoplication: a prospective randomized study with an 11-year follow-up. Ann Surg , 2007, 246(2): 201-206.
29.	Heikkinen TJ, Haukipuro K, Koivukangas P. Comparison of costs between laparoscopic and open Nissen fundoplication: a prospective randomized study with a 3-month followup. J Am CollSurg , 1999, 188(4): 368-376.
30.	Kösek V, Wykypiel H, Weiss H, et al . Division of the short gastric vessels during laparoscopic Nissen fundoplication: clinical and functional outcome during long-term follow-up in a prospectively randomized trial. Surg Endosc , 2009, 23(10): 2208-2213.
31.	Broeders JA, Rijnhart-de Jong HG, Draaisma WA, et al . Ten-year outcome of laparoscopic and conventional nissen fundoplication: randomized clinical trial. Ann Surg , 2009, 250(5): 698-706.
32.	Shaw JM, Bornman PC, Callanan MD, et al . Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial. Surg Endosc , 2010, 24(4): 924-932.
33.	Epstein D, Bojke L, Sculpher MJ, et al . Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: cost effectiveness study. BMJ , 2009, 339:b2576. doi: 10.1136/bmj.b2576.

1. 2 Corley DA, Kubo A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol , 2006, 101(11): 2619-2628.
2. 中华医学会消化内镜学分会. 反流性食管炎诊断及治疗指南（2003）. 中华消化内镜杂志, 2004, 21(4): 221-222.
3. El-Serag H. The association between obesity and GERD: a review of the epidemiological evidence. Dig Dis Sci , 2008, 53(9): 2307-2312.
4. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med , 2005, 143(3): 199-211.
5. Piesman M, Hwang I, Maydonovitch C, et al . Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? Am J Gastroenterol , 2007, 102(10): 2128-2134.
6. DiBaise JK. A randomized, double-blind comparison of two different coffee-roasting processes on development of heartburn and dyspepsia in coffee-sensitive individuals. Dig Dis Sci , 2003, 48(4): 652-656.
7. Cook MB, Kamangar F, Whiteman DC, et al . Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium. J Natl Cancer Inst , 2010, 102(17): 1344-1353.
8. Edelstein ZR, Bronner MP, Rosen SN, et al . Risk factors for Barrett's esophagus among patients with gastroesophageal reflux disease: a community clinic-based case-control study. Am J Gastroenterol , 2009, 104(4): 834-842.
9. Pehl C, Wendl B, Pfeiffer A. White wine and beer induce gastro-oesophageal reflux in patients with reflux disease. Aliment Pharmacol Ther , 2006, 23(11): 1581-1586.
10. Colombo P, Mangano M, Bianchi PA, et al . Effect of calories and fat on postprandial gastro-oesophageal reflux. Scand J Gastroenterol, 2002, 37(1): 3-5.
11. Galmiche JP, Fraitag B, Filoche B, et al . Double-blind comparison of cisapride and cimetidine in treatment of reflux esophagitis. Dig Dis Sci , 1990, 35(5): 649-655.
12. Khan M, Santana J, Donnellan C, et al . Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev , 2007, 18(2): CD003244.
13. van Pinxteren B, Numans ME, Bonis PA, et al . Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev , 2006, 19(3): CD002095.
14. Cutler A, Robinson M, Murthy A, et al . Rabeprazole 20 mg for erosive esophagitis-associated symptoms in a large, community-based study: additional results. Dig Dis Sci , 2010, 55(2): 338-345.
15. Pace F, Annese V, Prada A, et al . Rabeprazole is equivalent to omeprazole in the treatment of erosive gastro-oesophageal reflux disease. A randomised, double-blind, comparative study of rabeprazole and omeprazole 20 mg in acute treatment of reflux oesophagitis, followed by a maintenance open-label, low-dose therapy with rabeprazole. Dig Liver Dis, 2005, 37(10): 741-750.
16. Edwards SJ, Lind T, Lundell L. Systematic review: proton pump inhibitors (PPIs) for the healing of reflux oesophagitis - a comparison of esomeprazole with other PPIs. Aliment Pharmacol Ther , 2006, 24(5): 743-750.
17. 钟捷译. 埃索美拉唑与奥美拉唑对胃食管反流病24小时胃内PH效果比较. 中华消化杂志, 2003, 23(8): 391-492.
18. Kiljander TO, Junghard O, Beckman O, et al . Effect of esomeprazole 40 mg once or twice daily on asthma: a randomized, placebo-controlled study. Am J Respir Crit Care Med , 2010, 181(10):1042-1048.
19. Wu JC, Chan FK, Ching JY, et al . Effect of Helicobacter pylori eradication on treatment of gastro-esophageal reflux disease: a double blind, placebo controlled, randomized trial. Gut , 2004, 53(2):174-179.
20. Giannini EG, Zentilin P, Dulbecco P, et al . Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. Am J Gastroenterol , 2008, 103(2): 267-275.
21. Goh KL, Benamouzig R, Sander P, Efficacy of pantoprazole 20 mg daily compared with esomeprazole 20 mg daily in the maintenance of healed gastroesophageal reflux disease: a randomized, double-blind comparative trial - the EMANCIPATE study. Eur J Gastroenterol Hepatol , 2007, 19(3): 205-211.
22. Toussaint J, Gossuin A, Deruyttere M. Healing and prevention of relapse of reflux oesophagitis by cisapride. Gut , 1991, 32(11): 1280-1285.
23. 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.
24. Yaghoobi M, Farrokhyar F, Yuan Y, et al . Is there an increased risk of GERD after Helicobacter pylori eradication?: a meta-analysis. Am J Gastroenterol , 2010, 105(5): 1007-1013.
25. Schröder S, van Hülst S, Raabe W, et al . Nasojejunal enteral feeding tubes in critically ill patients. Successful placement without technical assistance. Anaesthesist , 2007, 56(12): 1217-1222.
26. Aziz AM, El-Khayat HR, Sadek A, et al . A prospective randomized trial of sham, single-dose Stretta, and double-dose Stretta for the treatment of gastroesophageal reflux disease. Surg Endosc , 2010, 24(4): 818-825.
27. Meneghelli UG, Boaventura S, Moraes-Filho JP, et al . Efficacy and tolerability of pantoprazole versus ranitidine in the treatment of reflux esophagitis and the influence of Helicobacter pylori infection on healing rate. Dis Esophagus , 2002, 15(1): 50-56.
28. Salminen PT, Hiekkanen HI, Rantala AP, et al . Comparison of long-term outcome of laparoscopic and conventional nissen fundoplication: a prospective randomized study with an 11-year follow-up. Ann Surg , 2007, 246(2): 201-206.
29. Heikkinen TJ, Haukipuro K, Koivukangas P. Comparison of costs between laparoscopic and open Nissen fundoplication: a prospective randomized study with a 3-month followup. J Am CollSurg , 1999, 188(4): 368-376.
30. Kösek V, Wykypiel H, Weiss H, et al . Division of the short gastric vessels during laparoscopic Nissen fundoplication: clinical and functional outcome during long-term follow-up in a prospectively randomized trial. Surg Endosc , 2009, 23(10): 2208-2213.
31. Broeders JA, Rijnhart-de Jong HG, Draaisma WA, et al . Ten-year outcome of laparoscopic and conventional nissen fundoplication: randomized clinical trial. Ann Surg , 2009, 250(5): 698-706.
32. Shaw JM, Bornman PC, Callanan MD, et al . Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial. Surg Endosc , 2010, 24(4): 924-932.
33. Epstein D, Bojke L, Sculpher MJ, et al . Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: cost effectiveness study. BMJ , 2009, 339:b2576. doi: 10.1136/bmj.b2576.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Treatment for First-visit Gastro-esophageal Reflux Disease

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