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.	陈旻湖, 侯晓华, 肖英莲, 等. 2014年中国胃食管反流病专家共识意见. 胃肠病学, 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.	铝碳酸镁多中心临床协作组. 铝碳酸镁治疗反流性食管炎的多中心临床观察. 中华内科杂志, 2001, 40(12): 819-822.
5.	邓盈军, 徐华, 王彩云, 等. 铝碳酸镁治疗反流性食道炎的近期临床疗效观察. 国际医药卫生导报, 2006, 12(16): 83-85.
6.	王战波, 陈玲玲, 游旭东. 联合应用埃索美拉唑、铝碳酸镁和莫沙比利治疗难治性胃食管反流病. 世界华人消化杂志, 2007, 15(8): 901-904.
7.	金锦莲, 谭成伟, 胡利兵. 雷贝拉唑联合铝碳酸镁治疗反流性食管炎 30 例疗效观察. 新医学, 2007, 38(1): 24-25.
8.	周家华. 三联疗法治疗胃食管反流病的临床疗效. 上海医学, 2008, 31(12): 886-887.
9.	方翰良, 方奇慧. 联合应用雷贝拉唑、铝碳酸镁和莫沙比利治疗难治性胃食管反流病 202 例疗效观察. 临床消化病杂志, 2009, 21(1): 49-51.
10.	许雪全, 王显飞. 奥美拉唑联合莫沙比利、铝碳酸镁治疗胃食管反流病疗效观察. 中国实用医刊, 2011, 38(2): 115-116.
11.	滕景侠. 奥美拉唑联合莫沙比利、铝碳酸镁治疗胃食管反流病的临床研究. 中国当代医药, 2012, 19(15): 50-51.
12.	冯建东. 泮托拉唑联合铝碳酸镁治疗胃食管反流病临床疗效观察. 中国医药导刊, 2013, 15(2): 283-284.
13.	陈龙, 陈福敏, 杜宗汉, 等. 埃索美拉唑联合莫沙必利、铝碳酸镁治疗难治性胃食管反流病的临床观察. 胃肠病学和肝病学杂志, 2013, 22(1): 57-59.
14.	姜齐宏, 陈艳, 王爱祥, 等. 铝碳酸镁片联合埃索美拉唑、黛力新治疗胃食管反流病 60 例. 世界华人消化杂志, 2013, 21(23): 2331-2334.
15.	禹晓娟. 铝碳酸镁与泮托拉唑在反流性食管炎治疗中的作用比较研究. 衡阳: 南华大学, 2014.
16.	董道文. 埃索美拉唑联合铝碳酸镁片和黛力新治疗胃食管反流病 70 例. 中国药业, 2014, 23(17): 90-91.
17.	李志明. 铝碳酸镁与泮托拉唑治疗反流性食管炎的疗效比较. 北方药学, 2016, 13(12): 94-95.
18.	徐柏兴, 李佳. 不同方法治疗难治性胃食管反流病的疗效观察. 中国实用医药, 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. 陈旻湖, 侯晓华, 肖英莲, 等. 2014年中国胃食管反流病专家共识意见. 胃肠病学, 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. 铝碳酸镁多中心临床协作组. 铝碳酸镁治疗反流性食管炎的多中心临床观察. 中华内科杂志, 2001, 40(12): 819-822.
5. 邓盈军, 徐华, 王彩云, 等. 铝碳酸镁治疗反流性食道炎的近期临床疗效观察. 国际医药卫生导报, 2006, 12(16): 83-85.
6. 王战波, 陈玲玲, 游旭东. 联合应用埃索美拉唑、铝碳酸镁和莫沙比利治疗难治性胃食管反流病. 世界华人消化杂志, 2007, 15(8): 901-904.
7. 金锦莲, 谭成伟, 胡利兵. 雷贝拉唑联合铝碳酸镁治疗反流性食管炎 30 例疗效观察. 新医学, 2007, 38(1): 24-25.
8. 周家华. 三联疗法治疗胃食管反流病的临床疗效. 上海医学, 2008, 31(12): 886-887.
9. 方翰良, 方奇慧. 联合应用雷贝拉唑、铝碳酸镁和莫沙比利治疗难治性胃食管反流病 202 例疗效观察. 临床消化病杂志, 2009, 21(1): 49-51.
10. 许雪全, 王显飞. 奥美拉唑联合莫沙比利、铝碳酸镁治疗胃食管反流病疗效观察. 中国实用医刊, 2011, 38(2): 115-116.
11. 滕景侠. 奥美拉唑联合莫沙比利、铝碳酸镁治疗胃食管反流病的临床研究. 中国当代医药, 2012, 19(15): 50-51.
12. 冯建东. 泮托拉唑联合铝碳酸镁治疗胃食管反流病临床疗效观察. 中国医药导刊, 2013, 15(2): 283-284.
13. 陈龙, 陈福敏, 杜宗汉, 等. 埃索美拉唑联合莫沙必利、铝碳酸镁治疗难治性胃食管反流病的临床观察. 胃肠病学和肝病学杂志, 2013, 22(1): 57-59.
14. 姜齐宏, 陈艳, 王爱祥, 等. 铝碳酸镁片联合埃索美拉唑、黛力新治疗胃食管反流病 60 例. 世界华人消化杂志, 2013, 21(23): 2331-2334.
15. 禹晓娟. 铝碳酸镁与泮托拉唑在反流性食管炎治疗中的作用比较研究. 衡阳: 南华大学, 2014.
16. 董道文. 埃索美拉唑联合铝碳酸镁片和黛力新治疗胃食管反流病 70 例. 中国药业, 2014, 23(17): 90-91.
17. 李志明. 铝碳酸镁与泮托拉唑治疗反流性食管炎的疗效比较. 北方药学, 2016, 13(12): 94-95.
18. 徐柏兴, 李佳. 不同方法治疗难治性胃食管反流病的疗效观察. 中国实用医药, 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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