H2 receptor antagonists and prokinetics in dyspepsia: a critical review

Bytzer, Peter

doi:10.1136/gut.50.suppl_4.iv58

Cited by 16 publications

(10 citation statements)

References 41 publications

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“…Consequently, these meta-analyses and systematic reviews are subject to the methodological weaknesses of the individual studies they include and pool. [19][20][21][22][23][24] Moher et al identified the importance of methodological quality assessment as part of meta-analysis to ensure an accurate estimation of effect size in intervention trials. 25 They concluded that studies of low methodological quality significantly inflated the estimates of effect size when included in meta-analyses.…”

Section: Introductionmentioning

confidence: 99%

The methodological quality of trials affects estimates of treatment efficacy in functional (non‐ulcer) dyspepsia

Abraham

Martin

Daniels

et al. 2004

Aliment Pharmacol Ther

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Summary Aim : To evaluate treatment efficacy using objective quality criteria. Methods : A systematic review was performed of randomized controlled trials of endoscopically investigated dyspepsia (1979–2003) using the Jadad score and Rome II guidelines. The Jadad score differentiated studies as ‘high quality’ (score 4–5/5) vs. ‘poor quality’ (score 1–3/5). Three key Rome II guidelines on study design (cut‐off of 0/3 or > 0/3) were also compared with the Jadad score. Results : Poor quality trials suggested a benefit of prokinetic therapy [relative risk (RR) of remaining dyspeptic, 0.47; 95% confidence interval (CI), 0.39–0.56), which was not confirmed in high quality trials (RR, 1.0; 95% CI, 0.84–1.19). There was a marked benefit of H2‐receptor antagonist therapy in poor quality trials (RR, 0.68; 95% CI, 0.61–0.76), but a marginal benefit in good quality trials (RR, 0.87; 95% CI, 0.79–0.97). Trial quality did not affect the small statistically significant benefit seen with Helicobacter pylori eradication. Two high quality trials suggested a limited benefit with the use of proton pump inhibitors, with no poor quality trials to provide a comparison. Separation of the studies by the Rome II criteria had a similar impact on the calculated treatment estimates. Conclusions : The magnitude of benefit of prokinetic and H2‐receptor antagonist therapies reported in previous meta‐analyses has been over‐estimated. The quality of trials has an impact on the efficacy estimates of treatment. The Rome II criteria for study methodology may be appropriate for judging study quality.

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Section: Introductionmentioning

confidence: 99%

The methodological quality of trials affects estimates of treatment efficacy in functional (non‐ulcer) dyspepsia

Abraham

Martin

Daniels

et al. 2004

Aliment Pharmacol Ther

View full text Add to dashboard Cite

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“…Functional dyspepsia is probably a multifactorial disorder 2 . Dyspeptic symptoms are chronic or frequently relapsing in most patients and drug treatment is often of little help 3 . The impact of the dyspeptic symptoms on daily activities may be even greater than in patients with organic dyspepsia 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Methods to identify true responders to drug treatment could thus prove very useful, although this is not an easy task. Placebo response rates are usually well above 50% in clinical trials, irrespective of the drug tested 3 . Symptom response to a drug, as judged by the outcome of a classical parallel group trial, will thus be a poor guide to the underlying pathophysiology in the individual patient.…”

Section: Discussionmentioning

confidence: 99%

“…However, a uniform response to drug therapy is not likely in a disease entity defined only by symptoms. This may be the background for the general failure of acid suppression therapy in functional dyspepsia demonstrated in most placebo‐controlled clinical trials 3 . Episodes of symptomatic functional disorders are likely to regress spontaneously; 4 many patients seek medical help, and may be recruited to clinical trials, at a time when their symptoms are most troublesome.…”

Section: Introductionmentioning

confidence: 99%

“…Episodes of symptomatic functional disorders are likely to regress spontaneously; 4 many patients seek medical help, and may be recruited to clinical trials, at a time when their symptoms are most troublesome. Furthermore, the placebo effect is usually well above 50% 3 , . 5 All of these aspects will tend to overestimate the true effects of the treatment.…”

Section: Introductionmentioning

confidence: 99%

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