PDF(Pubmed)
Abstract：
UNASSIGNED: Gastroesophageal reflux disease (GERD) is typically managed based on the clinical phenotype. We evaluated the efficacy and safety of potassium-competitive acid blockers (PCABs) in patients with various clinical GERD phenotypes.
UNASSIGNED: Core databases were searched for studies comparing PCABs and proton pump inhibitors (PPIs) in clinical GERD phenotypes of erosive reflux disease (ERD), non-erosive reflux disease (NERD), PPI-resistant GERD and night-time heartburn. Additional analysis was performed based on disease severity and drug dosage, and pooled efficacy was calculated.
UNASSIGNED: In 9 randomized controlled trials (RCTs) evaluating the initial treatment of ERD, the risk ratio for healing with PCABs versus PPIs was 1.09 (95% CI, 1.04-1.13) at 2 weeks and 1.03 (95% CI, 1.00-1.07) at 8 weeks, respectively. PCABs exhibited a significant increase in both initial and sustained healing of ERD compared to PPIs in RCTs, driven particularly in severe ERD (Los Angeles grade C/D). In 3 NERD RCTs, PCAB was superior to placebo in proportion of days without heartburn. Observational studies on PPI-resistant symptomatic GERD reported symptom frequency improvement in 86.3% of patients, while 90.7% showed improvement in PPIresistant ERD across 5 observational studies. Two RCTs for night-time heartburn had different endpoints, limiting meta-analysis. Pronounced hypergastrinemia was observed in patients treated with PCABs.
UNASSIGNED: Compared to PPIs, PCABs have superior efficacy and faster therapeutic effect in the initial and maintenance therapy of ERD, particularly severe ERD. While PCABs may be an alternative treatment option in NERD and PPI-resistant GERD, findings were inconclusive in patients with night-time heartburn.
UNASSIGNED: Core databases were searched for studies comparing PCABs and proton pump inhibitors (PPIs) in clinical GERD phenotypes of erosive reflux disease (ERD), non-erosive reflux disease (NERD), PPI-resistant GERD and night-time heartburn. Additional analysis was performed based on disease severity and drug dosage, and pooled efficacy was calculated.
UNASSIGNED: In 9 randomized controlled trials (RCTs) evaluating the initial treatment of ERD, the risk ratio for healing with PCABs versus PPIs was 1.09 (95% CI, 1.04-1.13) at 2 weeks and 1.03 (95% CI, 1.00-1.07) at 8 weeks, respectively. PCABs exhibited a significant increase in both initial and sustained healing of ERD compared to PPIs in RCTs, driven particularly in severe ERD (Los Angeles grade C/D). In 3 NERD RCTs, PCAB was superior to placebo in proportion of days without heartburn. Observational studies on PPI-resistant symptomatic GERD reported symptom frequency improvement in 86.3% of patients, while 90.7% showed improvement in PPIresistant ERD across 5 observational studies. Two RCTs for night-time heartburn had different endpoints, limiting meta-analysis. Pronounced hypergastrinemia was observed in patients treated with PCABs.
UNASSIGNED: Compared to PPIs, PCABs have superior efficacy and faster therapeutic effect in the initial and maintenance therapy of ERD, particularly severe ERD. While PCABs may be an alternative treatment option in NERD and PPI-resistant GERD, findings were inconclusive in patients with night-time heartburn.
摘要：
胃食管反流病(GERD)通常基于临床表型来管理。我们评估了钾竞争性酸阻滞剂（PCAB）在各种临床GERD表型患者中的疗效和安全性。
■在核心数据库中搜索比较PCAB和质子泵抑制剂（PPI）在糜烂性反流病（ERD）的临床GERD表型中的研究，非糜烂性反流病（NERD），PPI抗性GERD和夜间胃灼热。根据疾病严重程度和药物剂量进行额外分析，并计算合并疗效。
■在9项评估ERD初始治疗的随机对照试验（RCT）中，PCAB与PPI的愈合风险比在2周时为1.09（95％CI，1.04-1.13），在8周时为1.03（95％CI，1.00-1.07），分别。与RCT中的PPI相比，PCAB在ERD的初始和持续愈合中均显着增加，特别是在严重的ERD（洛杉矶C/D级）中。在3个NERDRCT中，PCAB在没有胃灼热的天数比例上优于安慰剂。对PPI耐药症状性GERD的观察性研究报告，86.3%的患者症状频率得到改善，而90.7%的人在5项观察性研究中表现出PPI抗性ERD的改善。两个夜间胃灼热的随机对照试验有不同的终点，限制性荟萃分析。在接受PCAB治疗的患者中观察到明显的高胃泌素血症。
■与PPI相比，PCAB在ERD的初始和维持治疗中具有优越的疗效和更快的治疗效果，尤其是严重的ERD。虽然PCAB可能是NERD和PPI耐药GERD的替代治疗选择，夜间胃灼热患者的研究结果尚无定论.
■在核心数据库中搜索比较PCAB和质子泵抑制剂（PPI）在糜烂性反流病（ERD）的临床GERD表型中的研究，非糜烂性反流病（NERD），PPI抗性GERD和夜间胃灼热。根据疾病严重程度和药物剂量进行额外分析，并计算合并疗效。
■在9项评估ERD初始治疗的随机对照试验（RCT）中，PCAB与PPI的愈合风险比在2周时为1.09（95％CI，1.04-1.13），在8周时为1.03（95％CI，1.00-1.07），分别。与RCT中的PPI相比，PCAB在ERD的初始和持续愈合中均显着增加，特别是在严重的ERD（洛杉矶C/D级）中。在3个NERDRCT中，PCAB在没有胃灼热的天数比例上优于安慰剂。对PPI耐药症状性GERD的观察性研究报告，86.3%的患者症状频率得到改善，而90.7%的人在5项观察性研究中表现出PPI抗性ERD的改善。两个夜间胃灼热的随机对照试验有不同的终点，限制性荟萃分析。在接受PCAB治疗的患者中观察到明显的高胃泌素血症。
■与PPI相比，PCAB在ERD的初始和维持治疗中具有优越的疗效和更快的治疗效果，尤其是严重的ERD。虽然PCAB可能是NERD和PPI耐药GERD的替代治疗选择，夜间胃灼热患者的研究结果尚无定论.
