Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies.

BACKGROUND Over-the-counter histamine-2 receptor antagonists, antacids and alginate/antacids are commonly used for gastro-oesophageal reflux disease. AIM To conduct a systematic review and meta-analysis of related treatment trials. METHODS We performed a systematic search and abstraction of randomized, placebo-controlled trials conducted during 1972-2005. Study quality was measured by the Jadad score (0-5). Results were pooled using random effects model. RESULTS Ten trials (n = 3442, placebo = 2940; Jadad score 3.5) showed a higher response with histamine-2 receptor antagonists in regard to complete relief of heartburn, symptomatic improvement, and episodes requiring rescue antacids. The absolute benefit increase was 10-12% and relative benefit increase was 19-41%. Four trials (n = 578, placebo = 577; Jadad score 3.5) showed a trend in favour of antacids in symptomatic improvement (absolute benefit increase 8%, 95% CI: 0-16%; relative benefit increase 0.11) and requirement of rescue antacids (OR 0.70, 95% CI: 0.59-0.84). Four trials (n = 146, placebo = 138; Jadad score 3.8) found alginate/antacid combination superior to placebo in symptomatic improvement (absolute benefit increase 26%, 95% CI: 12%-41%, relative benefit increase 0.60). CONCLUSIONS Over-the-counter medications are effective in treating symptomatic gastro-oesophageal reflux disease. Compared with the placebo response, which ranged between 37% and 64%, the relative benefit increase was up to 41% with histamine-2 receptor antagonists, 60% with alginate/antacid combinations, and 11% with antacids.