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Acid suppressant therapy is effective for short-term relief of heartburn for patients with persistent symptoms

Gastroesophageal reflux disease (GERD) inflames the esophagus due to the abnormal backflow of gastric contents into the esophagus. GERD's chief manifestation, heartburn, is experienced monthly by about one-fourth of adults in developed countries, and 5 percent suffer from heartburn daily. Acid suppressant therapy with a proton pump inhibitor (PPI) or a histamine-2 receptor antagonist (H2RA) is more effective than placebo for short-term relief of heartburn in patients with persistent symptoms, concludes a study supported by the Agency for Healthcare Research and Quality (HS09796).

After reviewing 1,408 studies, Joseph Lau, M.D., of New England Medical Center, and his colleagues conducted a meta-analysis of 13 studies that compared the short-term use of PPIs and H2RAs with each other or with placebo for relief of heartburn in adults with GERD. Adults were enrolled irrespective of endoscopic findings (3,433 empirical cases) or in whom endoscopy showed no signs of inflammation of the esophagus (2,520 with endoscopy-negative reflux disease, ENRD).

In the empirical treatment of GERD, H2RAs reduced the risk of heartburn by 23 percent over placebo, and in the only placebo-controlled trial, PPIs reduced the risk of heartburn over placebo by 65 percent. In treatment of ENRD, both PPIs and H2RAs were superior to placebo, and PPIs were superior to H2RAs.

See "Short-term treatment of gastroesophageal reflux disease," by Bart van Pinxteren, M.D., Mattijs E. Numans, M.D., Ph.D., Dr. Lau, and others, in the September 2003 Journal of General Internal Medicine 18, pp. 755-763.

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