Drug therapies for reducing gastric acidity in people with cystic fibrosis

Cochrane Database Syst Rev. 2012 Apr 18:(4):CD003424. doi: 10.1002/14651858.CD003424.pub2.

Abstract

Background: Malabsorption of fat and protein contributes to poor nutritional status in people with cystic fibrosis. Impaired pancreatic function may also result in increased gastric acidity, leading in turn to heartburn, peptic ulcers and the impairment of oral pancreatic enzyme replacement therapy. The administration of gastric acid-reducing agents has been used as an adjunct to pancreatic enzyme therapy to improve absorption of fat and gastro-intestinal symptoms in people with cystic fibrosis. It is important to establish the evidence regarding potential benefits of drugs that reduce gastric acidity in people with cystic fibrosis.

Objectives: To assess the effect of drug therapies for reducing gastric acidity for: nutritional status; symptoms associated with increased gastric acidity; fat absorption; lung function; quality of life and survival; and to determine if any adverse effects are associated with their use.

Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals, abstract books and conference proceedings.Most recent search of the Group's Trials Register: 15 February 2012.

Selection criteria: All randomised and quasi-randomised trials involving agents that reduce gastric acidity compared to placebo or a comparator treatment.

Data collection and analysis: Both authors independently selected trials, assessed trial quality and extracted data.

Main results: Thirty-eight trials were identified from the searches. Sixteen trials, with 256 participants, were suitable for inclusion. Seven trials were limited to children and three trials enrolled only adults. Meta-analysis was not performed. However, one trial found that drug therapies that reduce gastric acidity improved gastro-intestinal symptoms such as abdominal pain; seven trials reported significant improvement in measures of fat malabsorption; and two trials reported no significant improvement in nutritional status. Only one trial reported measures of respiratory function and one trial reported an adverse effect with prostaglandin E2 analogue misoprostol. No trials have been identified assessing the effectiveness of these agents in improving quality of life, the complications of increased gastric acidity, or survival.

Authors' conclusions: Trials have shown limited evidence that agents that reduce gastric acidity are associated with improvement in gastro-intestinal symptoms and fat absorption. Currently, there is insufficient evidence to indicate whether there is an improvement in nutritional status, lung function, quality of life, or survival. We therefore recommend that large, multicentre, randomised controlled clinical trials are undertaken to evaluate these interventions.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Abdominal Pain / drug therapy
  • Adult
  • Child
  • Cystic Fibrosis / complications*
  • Cystic Fibrosis / drug therapy
  • Dietary Fats / pharmacokinetics
  • Gastric Acid / metabolism*
  • Gastrointestinal Agents / therapeutic use
  • Histamine H2 Antagonists / therapeutic use*
  • Humans
  • Intestinal Absorption / drug effects
  • Pancreas / enzymology
  • Proton Pump Inhibitors*

Substances

  • Dietary Fats
  • Gastrointestinal Agents
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors