Efficacy of prokinetic drugs in combination with proton pump inhibitors versus proton pump inhibitors alone in the treatment of gastroesophageal reflux disease:a meta-analysis

In the present study,we aimed to systematically evaluate the efficacy of the combination therapy of prokinetics and proton pump inhibitors(PPIs)in patients with gastroesophageal reflux disease(GERD),and to provide an evidence-based reference for clinical use.The pertinent randomized controlled trials(RCTs)were retrieved from Pub Med and Embase.The quality of included studies was evaluated using the"risk of bias"tool for RCTs using the Rev Man 5.3.Related data were extracted according to the preset data collection forms.Meta-analysis was performed using Rev Man 5.3 and Stata 12.0 statistical software.Mean difference(MD)was used to describe the continuous variables,and relative ratio(RR)was used for classification variables.A total of 13 RCTs involving 1388 patients were included.Results of the meta-analysis showed that compared with PPI monotherapy,the combination therapy significantly improved the total response rate(RR=1.15,95%confidence interval(CI):(1.07,–1.24),P<0.001),gastroesophageal reflux disease questionnaire(GERD-Q)score(MD=–1.38,95%CI:(–2.12,–0.64),P<0.001),the frequency scale for the symptoms of gastroesophageal reflux(FSSG)score(MD=2.11,95%CI:(1.68,2.54),P<0.001)and visual analogue scale(MD=–0.69,95%CI:(–0.93,–0.45),P<0.001).However,the endoscopic response(RR=1.08,95%CI:(0.99,1.18),P=0.10)and symptomatic response(RR=1.22,95%CI:(0.94,1.59),P=0.13)were not significantly different between the two groups.For patients with GERD,the combination therapy could markedly improve the total response rate(symptomatic response and/or endoscopic response)and quality of life,while no benefits were found in symptomatic and endoscopic response.In view of the small number of participants included and some confounding factors in this study,the conclusion made in this study needs to be further confirmed by including a large number of participants and performing high-quality RCTs.

Gastric electrical stimulation for gastroparesis:A goal greatly pursued,but not yet attained

The lack of an effective medical treatment for gastroparesis has pushed the research of new techniques of gastric electrical stimulation (GES) for nearly half a century of experimentation with a large variety of electrical stimuli delivered to the gastric wall of animals and patients with gastroparesis. Three principal methods are currently available: gastric low-frequency/high-energy GES with long pulse stimulation, high-frequency/low-energy GES with short pulse stimulation and neural sequential GES. The first method aims to reset a regular slow wave rhythm, but has variable effects on contractions and requires devices with large and heavy batteries unsuitable for implantation. High-frequency/low-energy GES, although inadequate to restore a normal gastric electro-mechanical activity, improves dyspeptic symptoms, such as nausea and vomiting, giving patients a better quality of life together with a more satisfactory nutritional status and is suitable for implantation. Unfortunately, the numerous clinical studies using this type of GES, with the exception of two, were not controlled and there is a need for definitive verification of the effectiveness of this technique to justify the cost and the risks of this procedure. The last method, which is neural sequential GES, consists of a microprocessor-controlled sequential activation of a series of annular electrodes along the distal two thirds of the stomach and is able to induce propagated contractions causing forceful emptying of the gastric content. The latter method is the most promising, but has been used only in animals and needs to be tested in patients with gastroparesis before it is regarded as a solution for this disease.