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Additional bedtime H2-receptor antagonist for the control of nocturnal gastric acid breakthrough

Evidence Summaries

Level of Evidence = D

There is insufficient evidence on additional H2-receptor antagonist for the control of nocturnal gastric acid breakthrough.

A Cochrane review 1 included 8 studies with a total of 274 subjects. Additional bedtime H2RAs decreased the prevalence rate of nocturnal gastric acid breakthrough (RR 0.48, 95% CI 0.30 to 0.75, statistical heterogeneity I2=52%; 8 studies, n=274). Sub-group analyses showed that in short-term group additional bedtime H2RAs decreased the prevalence rate of nocturnal gastric acid breakthrough (RR 0.43, 95% CI 0.25 to 0.72, statistical heterogeneity I2=55%; 7 studies, n=254). In long-term group, additional bedtime H2RAs had no significant effect compared with control group (RR 0.75, 95% CI 0.41 to 1.36; 1 study, n=10). The results of the analyses for secondary outcomes showed that additional bedtime H2RAs decreased the percentage of time during which pH is less than 4.0 inside the stomach (MD -10.41, 95% CI -12.51 to -8.30, statistical heterogeneity I2=50%; 2 studies, n=72) and promoted median intragastric pH (MD 1.22, 95% CI 0.78 to 1.65, statistical heterogeneity I2=83%; 3 studies, n=116).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding), by inconsistency (variability in results across studies), and by indirectness (lack of long term studies).

References

1. Wang Y, Pan T, Wang Q, Guo Z. Additional bedtime H2-receptor antagonist for the control of nocturnal gastric acid breakthrough. Cochrane Database Syst Rev 2009;(4):CD004275.  [PMID:19821323]


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Citation

"Additional Bedtime H2-receptor Antagonist for the Control of Nocturnal Gastric Acid Breakthrough." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/450410/all/Additional_bedtime_H2_receptor_antagonist_for_the_control_of_nocturnal_gastric_acid_breakthrough.
Additional bedtime H2-receptor antagonist for the control of nocturnal gastric acid breakthrough. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/450410/all/Additional_bedtime_H2_receptor_antagonist_for_the_control_of_nocturnal_gastric_acid_breakthrough. Accessed August 21, 2019.
Additional bedtime H2-receptor antagonist for the control of nocturnal gastric acid breakthrough. (2019). In Evidence-Based Medicine Guidelines. Available from https://evidence.unboundmedicine.com/evidence/view/EBMG/450410/all/Additional_bedtime_H2_receptor_antagonist_for_the_control_of_nocturnal_gastric_acid_breakthrough
Additional Bedtime H2-receptor Antagonist for the Control of Nocturnal Gastric Acid Breakthrough [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2019 August 21]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/450410/all/Additional_bedtime_H2_receptor_antagonist_for_the_control_of_nocturnal_gastric_acid_breakthrough.
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TY - ELEC T1 - Additional bedtime H2-receptor antagonist for the control of nocturnal gastric acid breakthrough ID - 450410 BT - Evidence-Based Medicine Guidelines UR - https://evidence.unboundmedicine.com/evidence/view/EBMG/450410/all/Additional_bedtime_H2_receptor_antagonist_for_the_control_of_nocturnal_gastric_acid_breakthrough PB - Duodecim Medical Publications Limited DB - Evidence Central DP - Unbound Medicine ER -