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

doi:10.3748/wjg.v11.i26.4067

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Jul 14, 2005 (publication date) through Mar 6, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Clinical Research

World J Gastroenterol. Jul 14, 2005; 11(26): 4067-4077
Published online Jul 14, 2005. doi: 10.3748/wjg.v11.i26.4067

Table 1 Healing rate of esophagitis by ITT with standard dose vs high dose of H₂RA at 3, 4, 6, 8, 12 wk

		3-wk	4-wk	6-wk	8-wk	12-wk
Number of comparisons		1	5	9	5	12
High dose	Pooled data	29/169	297/669	607/1 294	413/669	1 142/1 729
	Pooled healing rate (%)	17.2	44.4	46.9	61.7	66.0
Standard dose	Pooled data	33/168	198/573	584/1 361	309/573	920/1 520
	Pooled healing rate (%)	19.6	34.6	42.9	53.9	60.5
Summary RR		0.874	1.281	1.096	1.165	1.084
95% CI		0.557-1.371	1.036-1.583	0.930-1.293	1.020-1.329	1.019-1.152

ITT, intention-to-treat analysis; No, number; RR, relative risk; 95%CI.

Table 2 Healing rate of esophagitis by ITT at 2, 3, 4, 8, 12 wk comparing proton pump inhibitors (PPIs) with H₂RA

	PPIs				H₂RA
	2-wk	4-wk	8-wk	12-wk	2-wk	4-wk	8-wk	12-wk
sd PPIs vs sd H₂RA
Number of arms	2	13	12		2	13	12
Pooled data	116/183	577/824	640/783		60/163	271/713	350/673
Pooled healing rate (%)	63.4	70.0	81.7		36.8	38.0	52.0
Summary RR	1.759	1.832	1.586
95%CI	1.398-2.213	1.622-2.070	1.438-1.749
hd PPIs vs sd H₂RA
Number of arms		4	4	1		4	4	1
Pooled data		150/204	175/201	72/80		79/211	106/207	49/81
Pooled healing rate (%)		73.5	87.1	90.0		37.4	51.2	60.5
Summary RR		1.722	1.623	1.488
95%CI		1.464-2.027	1.417-1.859	1.230-1.800
sd PPIs vs hd H₂RA
Number of arms		2	2		2	2
Pooled data		152/235	208/235		87/234	155/234
Pooled healing rate (%)		64.7	88.5		37.2	66.2
Summary RR		1.744	1.336
95%CI		1.442-2.110	1.206-1.481
ld PPIs vs sd H₂RA
Number of arms		3	3		3	3
Pooled data		187/279	219/279		120/276	161/276
Pooled healing rate (%)		67.0	78.5		43.5	58.3
Summary RR		1.605	1.374
95%CI		1.156-2.229	1.081-1.744

hd: high dose; sd: standard dose; ld: low dose; ITT, intention-to-treat analysis; No., number; RR, relative risk; 95% CI, 95% CIs.

Table 3 Healing rate (ITT) of esophagitis at 2, 4, 8 wk comparing PPIs with omeprazole

	Other PPIs			Omeprazole
	2-wk	4-wk	8-wk	2-wk	4-wk	8-wk
sd PPIs vs sd Omeprazole
Number of arms	1	12	12	1	12	12
Pooled data	264/421	2 615/3 412	3 050/3 411	257/431	2 229/3 217	2 719/3 216
Pooled healing rate (%)	62.7	76.6	89.4	59.6	69.3	84.5
Summary RR				1.052	1.044	1.061
95%CI				0.945–1.171	0.983-1.109	0.979-1.055
ld PPIs vs sd Omeprazole
Number of arms		2	2		2	2
Pooled data		590/822	724/822		551/811	707/811
Pooled healing rate (%)		71.8	88.1		67.9	87.2
Summary RR					1.026 0.981
95%CI					0.904-1.164	0.870-1.105
sd PPIs vs hd Omeprazole
Number of arms		2	1		2	1
Pooled data		310/440	284/337		302/434	282/332
Pooled healing rate (%)		70.5	84.3		69.6	84.9
Summary RR					1.031	0.985
95%CI					0.937-1.015	0.883-1.099

hd: high dose; sd: standard dose; ld: low dose; ITT, intention-to-treat analysis; No., number; RR, relative risk; 95% CI, 95% CIs.

Table 4 Healing rate of refractory esophagitis at 2, 4, 6, 8, 12 wk comparing PPIs with H₂RA

Author	PPIs						H₂RAs
	Number of			Healing rate ( ITT )			Number of			Healing rate ( ITT )
	Drug	Dose	Patient	4 wk	8 wk	12 wk	Drug	Dose	Patient	4 wk	8 wk	12 wk
sd PPIs vs sd H₂RA
Feldman ⁽⁵⁵⁾	Lan	30 o.d.	61		54/61		Ran	150 b.d.	32		12/32
Sontag ⁽⁵⁶⁾	Lan	30 o.d.	105	75/105	84/105		Ran	150 b.d.	54	28/54	16/54¹
Pooled data			166	75/105	138/166				86	28/54	28/86
Pooled rate (%)				71.4	83.1					51.9	32.6
hd PPIs vs hd H₂RA
Lundell ⁽⁵⁷⁾	Ome	40 o.d.	51	32/51	35/51	46/51	Ran	300 b.d.	47	8/47	18/47	22/47

Ome: omeprazole; Lan: lansoprazole; Ran: ranitidine; o.d.: once daily in the morning; b.d.: twice daily; h.d.: high dose; sd: standard dose. This study did not report cumulative healing rate at 8 wk. All patients’ endpoint was at 8 wk. The decreased healing rate at 8 wk for ranitidine group may be due to subsequent relapse of esophagitis.

Table 5 Healing by grade with standard dose vs high dose of H₂RA at 4, 6, 8, 12 wk (PP rate)

		4-wk		6-wk			8-wk		12-wk
		II	III	I	II	III	II	III	I	II	III
Number of arms		3	3	4	4	4	3	3	4	6	6
Standard dose	Pooled data	84/190	22/105	86/137	102/266	42/180	126/187	37/105	107/129	264/383	119/256
	Pooled rate (%)	44.2	21.0	62.8	38.3	23.3	67.4	35.2	82.9	69.0	46.5
High dose	Pooled data	177/325	60/198	112/157	120/272	60/214	226/323	92/198	122/153	400/532	190/376
	Pooled rate (%)	54.4	30.3	71.3	44.1	28.0	70.0	46.5	79.7	75.2	50.5
Summary RR
95% CI		1.231	1.430	1.136	1.150	1.200	1.039	1.316	0.962	1.032	1.059
		1.020-1.486	0.941-2.202	0.966-1.337	0.939-1.408	0.854-1.686	0.919-1.174	0.977-1.774	0.860-1.076	0.961-1.108	0.913-1.229

PP, per-protocol analysis; No., number; RR, relative risk; 95%CI.

Table 6 Healing by grade at 4, 8, 12 wk comparing PPIs with H₂RAs (PP rate)

		4 wk				8 wk				12 wk
		I	II	III	IV	I	II	III	IV	I	II
Number of arms		2	4	3		2	5	3	1
sd PPIs	Pooled data	53/60	128/162	20/54		23/23	166/178	28/47	2/3
	Pooled rate (%)	88.3	79.0	37.0		100.0	93.3	59.6	66.7
sd H₂RAs	Pooled data	27/54	65/172	2/41		16/25	101/182	6/34	0/2
	Pooled rate (%)	50.0	37.8	4.9		64.0	55.5	17.6	0
Summary RR		1.760	2.037	5.588		1.502	1.648	2.766	2.525
95%CI		1.329-2.332	1.631-2.545	1.701-18.363		1.107-2.038	1.440-1.885	1.284-5.916	1.046-6.093
No. of arms		2	4	2		2	4	2		1	1
hd PPIs	Pooled data	40/46	88/123	21/30		46/46	104/120	24/30		29/29	42/46
	Pooled rate (%)	87.0	71.5	70.0		100.0	86.7	80.0		100.0	91.3
sd H₂RAs	Pooled data	26/50	49/126	3/28		37/49	62/121	6/28		28/32	19/35
	Pooled rate (%)	52.0	38.9	10.7		75.5	51.2	21.4		87.5	54.3
Summary RR		1.665	1.835	6.110		1.300	1.689	3.626		1.111	1.676
95%CI		1.248-2.222	1.436-2.345	2.138-17.459		1.102-1.534	1.400-2.036	1.772-7.418		0.957-1.291	1.222-2.298
Number of arms		2	1	1		2	1	1
ld PPIs	Pooled data	144/175	34/42	9/28		162/175	42/44	15/28
	Pooled rate (%)	82.3	81.0	32.1		92.6	95.5	53.6
sd H₂RAs	Pooled data	104/175	15/50	1/22		132/175	27/49	2/21
	Pooled rate (%)	59.4	30.0	4.5		75.4	55.1	9.5
Summary RR		1.384	2.698	7.071		1.227	1.732	5.625
95%CI		1.202-1.592	1.724-4.224	0.967-51.707		1.116-1.349	1.335-2.249	1.440-21.980
Refractory esophagitis
Number of arms			1		1		2	1	2
sd PPIs	Pooled data		62/77		11/22		105/116	13/15	18/29
	Pooled rate (%)		80.5		50.0		90.5	86.7	62.1
sd H₂RAs	Pooled data		20/40		1/11		26/61	2/8	0/14
	Pooled rate (%)		50.0		9.1		42.6	25.0	0
Summary RR			1.606		5.500		2.117	3.229	35.881
95%CI			1.158-2.228		0.835-25.337		1.575-2.845	1.034-10.091	0.728-1767.6

sd: standard dose; ld: low dose.

Table 7 Healing by grade at 4, 8 wk comparing standard dose of other PPIs vs omeprazole

		4-wk				8-wk
		I	II	III	IV	I	II	III	IV
Number of arms		3	3	3	1	3	3	3	1
sd PPIs	Pooled data	195/239	302/362	148/210	3/7	214/235	329/360	175/209	2/4
	Pooled rate (%)	81.6	83.4	70.5	42.9	91.1	91.4	83.7	50.0
sd omeprazole	Pooled data	190/238	315/393	132/195	3/5	214/233	345/390	159/188	1/2
	Pooled rate (%)	79.8	80.2	67.8	60.0	91.8	88.5	84.6	50.0
Summary RR		1.022	1.041	1.041	0.733	0.992	1.033	0.990	1.000
95%CI		0.936-1.116	0.973-1.113	0.914-1.186	0.250-2.147	0.938-1.048	0.985-1.084	0.927-1.057	0.213-4.694

sd: standard dose.

Citation: Wang WH, Huang JQ, Zheng GF, Xia HHX, Wong WM, Lam SK, Wong BCY. Head-to-head comparison of H₂-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: A meta-analysis. World J Gastroenterol 2005; 11(26): 4067-4077
URL: https://www.wjgnet.com/1007-9327/full/v11/i26/4067.htm
DOI: https://dx.doi.org/10.3748/wjg.v11.i26.4067