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[The role of medical antireflux in asthmatics with gastroesophageal reflux:a systematic review].

Liu, Ying-Xia; Jiang, Shan-Ping; Tan, Yan-Fang.
Zhonghua Jie He He Hu Xi Za Zhi; 33(11): 823-30, 2010 Nov.
Artículo en Zh | MEDLINE | ID: mdl-21211369

OBJECTIVE:

to evaluate the effect of antireflux treatment in asthma patients with gastroesophageal reflux disease (GERD).

METHODS:

prospective randomized trials of antireflux treatment in asthma patients with gastroesophageal reflux were all included. Antireflux treatment should be double-blinded. Sample size and matching ways were not restricted. The study subjects were defined as asthmatic patients with gastroesophageal reflux aged 13 or older. Computer searching included The Cochrane Central Register of Controlled Trials, PubMed, Embase, OVID database, Chinese Biological Medicine database (CBMdisc), China National Knowledge Infrastructure (CNKI), and Wanfang Data. Manual searching included Chinese Journal of Tuberculosis and Respiratory Diseases, Chinese Journal of Digestion, Chinese Journal of Internal Medicine, CHEST and the references of trails included. The search ended on November of 2009. Trials with subjects using antireflux drugs in 3 days before entry, trials repeatly or mutiply published, and trials with methodology quality under grade B were excluded. With the method of Cochrane systematic review, 2 reviewers assessed the quality of the studies, extracted data independently and cross checked the data. Data were combined and analyzed with RevMan 4.3.2 to evaluate the effect of antireflux treatment on asthmatic patients with gastroesophageal reflux disease.

RESULTS:

fourteen randomized controlled studies met inclusion criteria, including 1555 cases. Meta-analyses demonstrated that antireflux treatment improved the pulmonary function in asthmatics with gastroesophageal reflux. Compared to the placebo group, FEV(1) improved [WMD 0.11 L; 95%CI (0.02 - 0.20); Z = 2.49, P = 0.010]; and PEF also improved, including daytime PEF [WMD 42.33 L/min; 95%CI (3.39 - 81.28), Z = 2.13, P = 0.030], morning PEF [WMD 16.16 L/min; 95%CI (5.91 - 26.41); Z = 3.09, P = 0.002], and nighttime PEF [WMD 18.35 L/min; 95%CI (6.77 - 29.92); Z = 3.11, P = 0.002]. However, no significant difference was found in the decrease of provocative concentration of acetylcholine causing a 20% decrease in FEV(1) (PC20-FEV(1)) [WMD -0.07 mg/L; 95%CI (-0.33 -0.19); Z = 0.55, P = 0.590]. Eight out of 14 studies showed improvement in asthma symptoms after antireflux treatment, but neither daytime symptoms nor nighttime symptoms showed significant improvement in this Meta-analysis.

CONCLUSION:

antireflux treatment in asthmatics with gastroesophageal reflux could improve pulmonary function, but showed no significant effect on airway hyper-responsiveness or asthma symptoms.