Meta-Analysis
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World J Gastroenterol. Dec 21, 2013; 19(47): 9111-9118
Published online Dec 21, 2013. doi: 10.3748/wjg.v19.i47.9111
Efficacy of mosapride plus proton pump inhibitors for treatment of gastroesophageal reflux disease: A systematic review
Qing Liu, Chen-Chen Feng, Er-Man Wang, Xiu-Juan Yan, Sheng-Liang Chen
Qing Liu, Chen-Chen Feng, Er-Man Wang, Xiu-Juan Yan, Sheng-Liang Chen, Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Institute of Digestive Disease, Shanghai Jiao Tong University, Shanghai 200001, China
Author contributions: Liu Q, Feng CC and Chen SL designed the research; Liu Q, Feng CC and Wang EM performed the literature search; Liu Q, Feng CC, Wang EM and Yan XJ collected and analyzed the data; Liu Q and Feng CC wrote the paper.
Supported by National Natural Science Foundation of China, No. 31171106, No. 81070302 and No. 81270463
Correspondence to: Sheng-Liang Chen, MD, Professor, Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Institute of Digestive Disease, Shanghai Jiao Tong University, 145 Middle Shandong Road, Shanghai 200001, China. slchenmd@hotmail.com
Telephone: +86-21-63200784 Fax: +86-21-63266027
Received: September 6, 2013
Revised: October 9, 2013
Accepted: December 13, 2013
Published online: December 21, 2013
Abstract

AIM: To assess the potential benefits of mosapride plus proton pump inhibitors (PPIs) in the treatment of gastroesophageal reflux disease.

METHODS: A literature search was performed through MEDLINE, EMBASE, and the ISI Web of Knowledge. The clinical trials that compared the benefit of mosapride plus PPI treatment with that of PPI monotherapy were analyzed. The rate of responders was evaluated by the pooled relative risk (PRR) and improvement in symptom scores was assessed by single effect size of a standardized mean, while Hedges’g was used as the effect size. Pooled effect sizes with 95%CIs were calculated using a fixed-effects model. Between-study heterogeneity was assessed using Q test and I2 analyses. In addition, studies that assessed the additional efficacy of mosapride in PPI-resistant patients were also reviewed.

RESULTS: This systematic review included information on a total of 587 patients based on 7 trials. Four trials compared the efficacy of combination therapy of mosapride plus a PPI with that of PPI monotherapy. The statistical analysis for the effect of additional mosapride showed equivocal results (PRR = 1.132; 95%CI: 0.934-1.372; P = 0.205; Hedges’g = 0.24; 95%CI: 0.03-0.46; P = 0.023). No heterogeneity and publication bias were found among the studies. Three open-labeled trials assessed the additional efficacy of mosapride in PPI-resistant patients. However, since these trials did not set the control group, the results may be considerably biased.

CONCLUSION: Mosapride combined therapy is not more effective than PPI alone as first-line therapy. Whether it is effective in PPI-resistant patients needs to be determined.

Keywords: Mosapride, Proton pump inhibitor, Gastroesophageal reflux disease, Systematic review, Combined therapy

Core tip: Prokinetic agents have been widely used to relieve the gastroesophageal reflux disease (GERD) symptoms, and mosapride is a selective 5-HT4 receptor agonist that can be safely used. We conducted a systematic review and meta-analysis to assess the potential benefits of the addition of mosapride to proton pump inhibitors (PPIs) in the treatment of GERD. Based on this research, mosapride combined therapy seems to be not more effective than PPI alone as first-line therapy. Whether it is effective in PPI-resistant patients needs to be determined.