Efficacy of esophagus protection in complex treatment of erosive gastroesophageal reflux disease: a systematic review and meta-analysis of controlled trials

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Abstract

Aim. To review the data about the efficacy of esophagus protective agent based on the fixed combination of hyaluronic acid and chondroitin sulfate dissolved in the bioadhesive carrier (poloxamer 407) in the complex therapy of patients with erosive gastroesophageal reflux disease (GERD).

Materials and methods. A search in MEDLINE/PubMed, EMBASE, Cochrane, and Russian Science Citation Index of Scientific Electronic Library electronic databases was performed. Relevant original controlled studies of a fixed combination of hyaluronic acid and chondroitin sulfate as an esophagus protective agent in a population of patients with erosive GERD were included.

Results. The final analysis included three studies that enrolled 181 patients with erosive GERD. All the studies had a uniform design with the assessment of the primary endpoints (complete epithelialization of esophageal erosions and complete resolution of heartburn) 28 days after the start of therapy. Meta-analysis of the three controlled trials has demonstrated that combination therapy with proton pump inhibitors (PPIs) and esophagus protective agents is significantly more effective than PPI monotherapy for complete epithelialization of esophageal erosions at 28 days of treatment (relative risk 1.267, 95% confidence interval 1.082–1.483, p=0.003; I2=21.19%), but did not differ for complete resolution of heartburn on the day 28 of treatment (relative risk 1.638, 95% confidence interval 0.660–4.067, p=0.287; I2=92.59%).

Conclusion. Combined therapy with PPI and Alfasoxx is significantly more effective than PPI monotherapy for the epithelialization of esophageal erosions in patients with erosive GERD.

About the authors

Dmitry S. Bordin

Yevdokimov Moscow State University of Medicine and Dentistry; Loginov Moscow Clinical Scientific Center; Tver State Medical University

Email: dna-mit8@mail.ru
ORCID iD: 0000-0003-2815-3992

д-р мед. наук, проф. каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова», зав. отд. патологии поджелудочной железы, желчных путей и верхних отделов пищеварительного тракта ГБУЗ «МКНЦ им. А.С. Логинова», проф. каф. общей врачебной практики и семейной медицины ФГБОУ ВО «Тверской ГМУ»

Russian Federation, Moscow; Moscow; Tver

Dmitry N. Andreev

Yevdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: dna-mit8@mail.ru
ORCID iD: 0000-0002-4007-7112

канд. мед. наук, доц. каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»

Russian Federation, Moscow

Igor V. Maev

Yevdokimov Moscow State University of Medicine and Dentistry

Email: dna-mit8@mail.ru
ORCID iD: 0000-0001-6114-564X

акад. РАН, д-р мед. наук, проф., зав. каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»

Russian Federation, Moscow

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2. Fig. 1. CONSORT diagram of the study selection strategy in detail.

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3. Fig. 2. Efficacy of combination therapy with proton pump inhibitors (pantoprazol) and Alfasoxx versus monotherapy of proton pump inhibitors (pantoprazol) in total esophageal erosion epithelialization by 28 days of treatment.

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4. Fig. 3. Efficacy of combination therapy with proton pump inhibitors (pantoprazol) and Alfazoxx versus monotherapy of proton pump inhibitors (pantoprazol) until complete treatment of heartburn by 28 days.

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