Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: A meta-analysis

Abstract

AIM: To systematically evaluate the efficacy of H₂-receptor antagonists (H₂RAs) and proton pump inhibitors in healing erosive esophagitis (EE).

METHODS: A meta-analysis was performed. A literature search was conducted in PubMed, Medline, Embase, and Cochrane databases to include randomized controlled head-to-head comparative trials evaluating the efficacy of H₂RAs or proton pump inhibitors in healing EE. Relative risk (RR) and 95% confidence interval (CI) were calculated under a random-effects model.

RESULTS: RRs of cumulative healing rates for each comparison at 8 wk were: high dose vs standard dose H₂RAs, 1.17 (95%CI, 1.02-1.33); standard dose proton pump inhibitors vs standard dose H₂RAs, 1.59 (95%CI, 1.44-1.75); standard dose other proton pump inhibitors vs standard dose omeprazole, 1.06 (95%CI, 0.98-1.06). Proton pump inhibitors produced consistently greater healing rates than H₂RAs of all doses across all grades of esophagitis, including patients refractory to H₂RAs. Healing rates achieved with standard dose omeprazole were similar to those with other proton pump inhibitors in all grades of esophagitis.

CONCLUSION: H₂RAs are less effective for treating patients with erosive esophagitis, especially in those with severe forms of esophagitis. Standard dose proton pump inhibitors are significantly more effective than H₂RAs in healing esophagitis of all grades. Proton pump inhibitors given at the recommended dose are equally effective for healing esophagitis.

Keywords: Erosive esophagitis, H₂-receptor antagonists, Proton pump inhibitors, Meta-analysis