Meta Analysis Of Proton Pump Inhibitors In The Treatment Of Gastroesophageal Reflux Laryngitis

ObjectiveTo investigate the clinical efficacy and safety of PPI in the treatment of GERL, provides a better theoretical basis for clinical treatment and scientific processing GERL.Research methodsFirst of all, gastro esophageal reflux laryngitis and proton pump inhibitor were used for the keywords and searched in the WEB OF SCIENCE, COCHRANE LIBERAY, EMBASE, PUBMED, CENTRAL, EMbase, VIP, CNKI, CBM and WANFANG databases to find all the control tests involving the PPI inhibitors on the treatment of gastroesophageal reflux and the treatment of pharyngitis in all the randomized clinical studies on various proton pump(Randomized controlled clinical trial, RCT), and the time limit for retrieval of starting from the establishment to May 20, 2014. Then, according to the gastroesophageal reflux laryngitis randomized controlled clinical trials of standard search and screening out qualified, then determines the research object according to the study on the indexes related to the baseline the level of the extracted RCT data and a variety of related, according to the GRADE score standard to evaluate and incorporated into the quality of this research, according to inclusion and exclusion criteria for screening, data extraction and quality assessment of the literature on the reflux symptom index, using the software revman5.2(Reflux symptom index, RSI) overall efficiency(anti flow symptom index), reflux examination score Backflow test scores(Reflux examination score, RFS) and Other indicators of Meta analysis. Screening, data extraction and quality assessment according to inclusion and exclusion criteria, it is the analysis of randomized controlled trials conducted by 6 researchers independently of the Meta, using Rev Man 5.2 software, quality evaluation and the use of hierarchical system of evidence. Finally carries on the statistics and analysis of the obtained data, draw relevant research index further to guide clinical practice.Results1.The general results A total of 741 records from databases and references of relative articles were retrieved. After the first screen by abstracts, 17 full-text articles were retrieved for further review. After rigorous selection, 3 trails were excluded for the reason of not comparing with placebo. Thus,14 eligible RCTs were included and analyzed.2.Clinic Outcomes Patients with >50% reduction in laryngeal symptoms(which was classified as the response to treatment) were extracted from each study. A total of 10 RCTs with 400 participants were included in this analysis. By pooling all eligible trials, we found that patients who received PPI treatment had a significantly higher response rate than those who received placebo(Fig2; risk difference=0.15;95% CI, 0.01-0.30; P=0.01).RSI is a self-administered outcome instrument and RSI is a generally used measure of reflux symptoms. The meta-analysis results showed that for patients who received PPI therapy, the total RSI improved more significantly than in those who received placebo(SMD=1.65;95% CI, 0.15-3.14;P<0.01).3. The clinical symptoms Compared with placebo,PPI therapy improved the symptoms of hoarseness significantly(SMD=0.77; 95% CI, 0.14-1.39;P=0.02), but PPIs failed to provide better improvement for throat clearing(SMD=0.85;95% CI,-0.39 to 2.08;P>0.05).4. Endoscopic examination Laryngoscopy is often used for the diagnosis of LPR as LPR often leads to posterior laryngeal mucosal abnormalities.The RFS was also analyzed to evaluate PPIs’ effect on the laryngeal mucosa. Pooled results showed that the PPI could not provide better improvement of RFS than the placebo(SMD=0.62; 95% CI,-0.96 to 2.19;P>0.05).5. The adverse reaction In the 14 study, only 2 studies show, take the adverse effects of GERL therapy in PPI patients is higher than that of the control group. But because of insufficient sample size, unable to carry out sensitivity analysis.ConclusionsPPI can alleviate the obvious advantages of gastroesophageal reflux pharyngitis symptoms. In the evaluation of clinical effect in the treatment of gastroesophageal reflux laryngitis patients in, because of the existence of heterogeneity among studies involved, this evaluation system at present cannot provide a reliable basis for the best way to treat PPI, randomized controlled trials need more high quality, large sample, multi center studies to further demonstration.