Efficacy of esophagus protection in complex treatment of erosive gastroesophageal reflux disease: a systematic review and meta-analysis of controlled trials
- Authors: Bordin D.S.1,2,3, Andreev D.N.1, Maev I.V.1
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Affiliations:
- Yevdokimov Moscow State University of Medicine and Dentistry
- Loginov Moscow Clinical Scientific Center
- Tver State Medical University
- Issue: Vol 94, No 12 (2022)
- Pages: 1407-1412
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/144204
- DOI: https://doi.org/10.26442/00403660.2022.12.202011
- ID: 144204
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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.
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##article.viewOnOriginalSite##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; TverDmitry 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, MoscowIgor 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, MoscowReferences
- Ивашкин В.Т., Маев И.В., Трухманов А.С., и др. Рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению гастроэзофагеальной рефлюксной болезни. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2020;30(4):70-97 [Ivashkin VT, Maev IV, Trukhmanov AS, et al. Recommendations of the Russian Gastroenterological Association in Diagnosis and Treatment of Gastroesophageal Reflux Disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(4):70-97 (in Russian)]. doi: 10.22416/1382-4376-2020-30-4-70-97
- Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022;117(1):27-56. doi: 10.14309/ajg.0000000000001538
- Маев И.В., Бусарова Г.А., Андреев Д.Н. Болезни пищевода. М.: ГЭОТАР-Медиа, 2019 [Maev IV, Busarova GA, Andreev DN. Bolezni pishchevoda. Moscow: GEOTAR-Media, 2019 (in Russian)].
- Pandit S, Boktor M, Alexander JS, et al. Gastroesophageal reflux disease: A clinical overview for primary care physicians. Pathophysiology. 2018;25(1):1-11. doi: 10.1016/j.pathophys.2017.09.001
- Bor S, Lazebnik LB, Kitapcioglu G, et al. Prevalence of gastroesophageal reflux disease in Moscow. Dis Esophagus. 2016;29(2):159-65. doi: 10.1111/dote.12310
- Бордин Д.С., Абдулхаков Р.А., Осипенко М.Ф., и др. Многоцентровое исследование распространенности симптомов гастроэзофагеальной рефлюксной болезни у пациентов поликлиник в России. Терапевтический архив. 2022;94(1):48-56 [Bordin DS, Abdulkhakov RА, Osipenko MF, et al. Multicenter study of gastroesophageal reflux disease symptoms prevalence in outpatients in Russia. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):48-56 (in Russian)]. doi: 10.26442/00403660.2022.01.201322
- Ronkainen J, Aro P, Storskrubb T, et al. High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report. Scand J Gastroenterol. 2005;40(3):275-85. doi: 10.1080/00365520510011579
- Azer SA, Reddivari AKR. Reflux Esophagitis. 2022 May 1. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2022.
- Sakaguchi M, Manabe N, Ueki N, et al. Factors associated with complicated erosive esophagitis: A Japanese multicenter, prospective, cross-sectional study. World J Gastroenterol. 2017;23(2):318-27. doi: 10.3748/wjg.v23.i2.318
- Takenouchi N, Hoshino S, Hoshikawa Y, et al. Risk of hemorrhage and stricture significantly increases in elderly patients with proton pump inhibitor (PPI)-resistant reflux esophagitis. Esophagus. 2020;17(1):87-91. doi: 10.1007/s10388-019-00702-y
- Ronkainen J, Talley NJ, Storskrubb T, et al. Erosive esophagitis is a risk factor for Barrett's esophagus: a community-based endoscopic follow-up study. Am J Gastroenterol. 2011;106(11):1946-52. doi: 10.1038/ajg.2011.326
- Маев И.В., Баркалова Е.В., Овсепян М.А., и др. Показатели рН-импедансометрии и манометрии пищевода высокого разрешения у пациентов с различными формами гастроэзофагеальной рефлюксной болезни. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2018;28(4):23-35 [Maev IV, Barkalova EV, Ovsepyan MA, et al. Indicators of Esophageal pH-Impedance Monitoring and High-Resolution Manometry in Patients with Various Forms of Gastroesophageal Reflux Disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(4):23-35 (in Russian)]. doi: 10.22416/1382-4376-2018-28-4-23-35
- Маев И.В., Баркалова Е.В., Кучерявый Ю.А., и др. Паттерны эзофагеальной ацидификации и нарушений моторики при заболеваниях пищевода. Вестник Российской академии медицинских наук. 2020;75(2):96-105 [Maev IV, Barkalova EV, Kucheryavyy YuA, et al. Patterns of Esophageal Acidification and Impairment of Esophageal Motility in Gastroesophageal Reflux Disease and Barrett’s Esophagus. Annals of the Russian Academy of Medical Sciences. 2020;75(2):96-105 (in Russian)]. doi: 10.15690/vramn1211
- Mermelstein J, Chait Mermelstein A, Chait MM. Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions. Clin Exp Gastroenterol. 2018;11:119-34. doi: 10.2147/CEG.S121056
- Маев И.В., Андреев Д.Н., Кучерявый Ю.А., Шабуров Р.И. Современные достижения в лечении гастроэзофагеальной рефлюксной болезни: фокус на эзофагопротекцию. Терапевтический архив. 2019;91(8):4-11 [Maev IV, Andreev DN, Kucheryavyy YA, Shaburov RI. Current advances in the treatment of gastroesophageal reflux disease: a focus on esophageal protection. Terapevticheskii Arkhiv (Ter. Arkh.). 2019;91(8):4-11 (in Russian)]. doi: 10.26442/00403660.2019.08.000387
- Эмбутниекс Ю.В., Валитова Э.Р., Бордин Д.С. Новый подход к лечению гастроэзофагеальной рефлюксной болезни: защита слизистой оболочки пищевода. Эффективная фармакотерапия. 2019;15(18):16-22 [Embutnieks YuV, Valitova ER, Bordin DS. The New Approach to the Treatment of Gastroesophageal Reflux Disease: the Protection of the Esophageal Mucosa. Effective Pharmacotherapy. 2019;15(18):16-22 (in Russian)]. doi: 10.33978/2307-3586-2019-15-18-16-22
- Savarino E, Zentilin P, Marabotto E, et al. Drugs for improving esophageal mucosa defense: where are we now and where are we going? Ann Gastroenterol. 2017;30(6):585-91. doi: 10.20524/aog.2017.0187
- Palmieri B, Merighi A, Corbascio D, et al. Fixed combination of hyaluronic acid and chondroitin-sulphate oral formulation in a randomized double blind, placebo controlled study for the treatment of symptoms in patients with non-erosive gastroesophageal reflux. Eur Rev Med Pharmacol Sci. 2013;17:3272-8.
- Savarino V, Pace F, Scarpignato C, Esoxx Study Group. Randomised clinical trial: mucosal protection combined with acid suppression in the treatment of non-erosive reflux disease – efficacy of Esoxx, a hyaluronic acid-chondroitin sulphate based bioadhesive formulation. Aliment Pharmacol Ther. 2017;45:631-42. doi: 10.1111/apt.13914. Epub 2017 Jan 24.
- Chmielecka-Rutkowska J, Tomasik B, Pietruszewska W. Rola doustnego preparatukwasu hialuronowego i siarczanu chondroityny w leczeniu pacjentówz refluksem krtaniowo-gardłowym. Otolaryngol Pol. 2019;73(6):38-49. doi: 10.5604/01.3001.0013.5776
- Березина О.И., Валитова Э.Р., Быстровская Е.В., Бордин Д.С. Комбинированная терапия гастроэзофагеальной рефлюксной болезни. Эффективная фармакотерапия. 2021;17(16):32-9 [Berezina OI, Valitova ER, Bystrovskaya EV, Bordin DS. Combined Therapy of Gastroesophageal Reflux. Effective Pharmacotherapy. 2021;17(16):32-9 (in Russian)]. doi: 10.33978/2307-3586-2021-17-16-32-39
- Матошина И.В., Ливзан М.А., Федорин М.М., Лаптева И.В. Эффективность комбинированной терапии больных эрозивной гастроэзофагеальной рефлюксной болезнью. РМЖ. Медицинское обозрение. 2021;5(6):366-72 [Matoshina I, Livzan MA, Fedorin MM, Lapteva IV. Efficacy of combined therapy in patients with erosive gastroesophageal reflux disease. Russian Medical Inquiry. 2021;5(6):366-72 [(in Russian)]. doi: 10.32364/2587-6821-2021-5-6-366-372
- Бакулина Н.В., Тихонов C.В., Топалова Ю.Г., и др. Эзофагопротективная терапия у пациентов с эрозивным эзофагитом. Терапевтический архив. 2022;94(8):985-91 [Bakulina NV, Tikhonov SV, Topalova YG, et al. Esophagoprotective therapy in patients with erosive esophagitis. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(8):985-91 (in Russian)]. doi: 10.26442/00403660.2022.08.201828
- Маев И.В., Дичева Д.Т., Андреев Д.Н. Подходы к индивидуализации лечения гастроэзофагеальной рефлюксной болезни. Эффективная фармакотерапия. 2012;4:18-22 [Maev IV, Dicheva DT, Andreev DN. Approaches to individualization of treatment of gastroesophageal reflux disease. Effective Pharmacotherapy. 2012;4:18-22 (in Russian)].
- Маев И.В., Андреев Д.Н., Овсепян М.А., Баркалова Е.В. Гастроэзофагеальная рефлюксная болезнь: факторы риска, современные возможности диагностики и оптимизации лечения. Медицинский совет. 2022;7:16-26 [Maev IV, Andreev DN, Ovsepyan MA, Barkalova EV. Gastroesophageal reflux disease: risk factors, current possibilities of diagnosis and treatment optimization possibilities of diagnosis and treatment optimisation. Meditsinskiy sovet. 2022;7:16-26 (in Russian)]. doi: 10.21518/2079-701X-2022-16-7-16-26
- Blackshaw LA, Bordin DS, Brock C, et al. Pharmacologic treatments for esophageal disorders. Ann N Y Acad Sci. 2014;1325:23-39. doi: 10.1111/nyas.12520
- Бордин Д.С. «Кислотный карман» как патогенетическая основа и терапевтическая мишень при гастроэзофагеальной рефлюксной болезни. Терапевтический архив. 2014;2:76-81 [Bordin DS. The acid pocket as the pathogenic basis and therapeutic target in gastroesophageal reflux disease. Terapevticheskii Arkhiv (Ter. Arkh.). 2014;86(2):76-81 (in Russian)].
- Маев И.В., Андреев Д.Н., Кучерявый Ю.А., и др. Эффективность эзофагопротектора в лечении пациентов с гастроэзофагеальной рефлюксной болезнью: систематический обзор. Медицинский совет. 2022;15:20-6 [Maev IV, Andreev DN, Kucheryavyy YuA, et al. Efficacy of an esophageal mucosal protectant in the treatment of patients with gastroesophageal reflux disease: a systematic review. Meditsinskiy sovet = Medical Council. 2022;15:20-6 (in Russian)]. doi: 10.21518/2079-701X-2022-16-15-20-26
- Xu C, Niu X. Progress on the Mechanism of Visceral Hypersensitivity in Nonerosive Reflux Disease. Gastroenterol Res Pract. 2022;2022:4785077. doi: 10.1155/2022/4785077
- Norita K, Asanuma K, Koike T, et al. Impaired Mucosal Integrity in Proximal Esophagus Is Involved in Development of Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease. Digestion. 2021;102(3):404-14. doi: 10.1159/000508661
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