Pharmacological interventions for non-ulcer dyspepsia

Martin, Paul; Soo, Shelly; Deeks, Jonathan J; Delaney, Brendan; Forman, David

doi:10.1002/14651858.cd001960.pub2

Cited by 59 publications

(70 citation statements)

References 90 publications

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“…They concluded that the magnitude of benefit derived from therapies with prokinetics or H 2 RA reported in previous meta-analyses had been overestimated and that the quality of the trials affects the estimation of treatment efficacy. 18 Moayyedi et al 19 performed a meta-analysis to evaluate the effectiveness of several drugs in improving either individual or global dyspepsia symptom scores and also QOL scores of patients with nonulcer dyspepsia (NUD) and showed that prokinetics (14 trials with dichotomous outcomes, 1053 patients in all), H 2 RAs (11 trials, 2164 patients), and proton-pump inhibitors (PPIs; eight trials, 3293 patients) were significantly more effective than placebo. However, they found that trials evaluating prokinetics therapy were difficult to interpret, and the meta-analysis result might reflect publication bias.…”

Section: Meta-analyses Of the Effects Of Antisecretory Drugs And Prokmentioning

confidence: 99%

“…However, they found that trials evaluating prokinetics therapy were difficult to interpret, and the meta-analysis result might reflect publication bias. 19 Trials evaluating the effect of antisecretory drugs or prokinetics (Table 2) In 2002, Wong et al 20 found in a randomized placebocontrolled study of Chinese patients (n = 453) that treatment with lansoprazole (30 or 15 mg daily) is not superior to placebo for the management of FD. On the other hand, Bollong-Sternevald et al 21 evaluated the effect of another PPI, omeprazole, in a study of 197 FD patients, randomly allocated to a double-blind treatment with omeprazole 20 mg or placebo for 14 days, and concluded that a subset of patients with FD responds to therapy with omeprazole.…”

Section: Meta-analyses Of the Effects Of Antisecretory Drugs And Prokmentioning

confidence: 99%

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Therapeutic strategies for functional dyspepsia and the introduction of the Rome III classification

2006

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Although placebo response rates in clinical trials for functional dyspepsia (FD) are more than 30%, a recent meta-analysis based on randomized controlled trials (RCTs) showed that antisecretory drugs were more or less superior to placebos. On the other hand, large-scale RCTs on the efficacy of treatment with prokinetics on FD are still needed. Indications for antibiotic eradication therapy for Helicobacter pylori-positive FD are still controversial, but there seems to be a small but significant therapeutic gain achieved with H. pylori eradication. Since preprandial and postprandial symptomatic disturbances are very important targets for FD treatment, ghrelin, a novel appetite-promoting gastrointestinal peptide that also promotes gastric motility or basal acid secretion can be expected to be a therapeutic target. In the recently published Rome III classification, FD is redefined for patients with symptoms thought to originate from the gastroduodenal region, specifically epigastric pain or burning, postprandial fullness, or early satiation, and it is divided into the subcategories postprandial distress syndrome and epigastric pain syndrome. These new criteria are of value in clinical practice, for epidemiological, pathophysiological, and clinical research, and for the development of new therapeutic strategies.

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Section: Meta-analyses Of the Effects Of Antisecretory Drugs And Prokmentioning

confidence: 99%

Section: Meta-analyses Of the Effects Of Antisecretory Drugs And Prokmentioning

confidence: 99%

Therapeutic strategies for functional dyspepsia and the introduction of the Rome III classification

2006

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“…Eine Cochrane-Analyse [31] fand zwar für H 2 -Antagonisten eine signifikante Verbesserung dyspeptischer Beschwerden, kommt aber zu dem Ergebnis, dass dieses wesentlich durch positive Befunde aus kleinen Studien beeinflusst wird, während alle größeren klinischen Studien einen maximal geringen bis keinen signifikanten Effekt berichten [16,32]. Darüber hinaus wird die Wirksamkeit durch die Zusammensetzung des Patientenkollektivs und einen überproportionalen Anteil der Patienten mit einer nichterosiven Refluxerkrankung beinflusst.…”

Section: Antazida Und Histaminrezeptorantagonistenunclassified

“…In einer kürzlich erschienenen CochraneMetaanalyse [31] zeigt sich eine signifikante Überlegenheit von PPI gegenüber Plazebo, wenn man als primären Endpunkt "ausreichende Symptomenbesserung" oder "keine bis minimale Symptome" sowie eine Ansprechrate auf Plazebo von 22 annimmt. Die notwendige Therapiedauer für einen ausreichenden therapeutischen Effekt liegt bei mindestens 4 und maximal 8 Wochen.…”

Section: Protonenpumpeninhibitoren (Ppi)unclassified

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Funktionelle Dyspepsie – eine Verlegenheitsdiagnose?

2006

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Dyspepsia comprises a broad spectrum of predominantly upper abdominal symptoms, such as pain, indigestion, nausea, early satiety and bloating. While these symptoms are highly prevalent, in less than 50% of patients presenting with dyspepsia, structural lesions or biochemical abnormalities are found that explain the symptoms when routine clinical tests are used. In patients without structural lesions the diagnosis of functional dyspepsia is justified. Exclusion of life-threatening disorders as the cause of symptoms and reassurance of the patient as well as proper explanation of the diagnosis and its underlying disease mechanisms (i.e. symptoms are due to a sensitive gut) is crucial and can be considered as an essential element of treatment. Since there is a remarkable comorbidity of anxiety and depression, psychosomatic interventions might be necessary in selected patients. Based on controlled clinical trials few drugs, such as proton pump inhibitors, prokinetics, tricyclic antidepressants, simethicone and selected herbal preparations have been found to be effective for treatment of functional dyspepsia. Effects of H. pylori eradication, even though strongly advocated, are most likely due to undiagnosed peptic ulcer disease in a very small group of patients. While there is currently no therapy that cures functional dyspepsia, the therapeutic target is to control symptoms.

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