1. Class 1 6 1 st Year Introdução à Medicina I FMUP 19 th December 2007

2. Class 1 6 1 st Year Doutor Mário Dinis Ribeiro Introdução à Medicina I FMUP Ana Lopes Andreia Pinto Catarina Melo Diogo Dias Isabel Saavedra João Matias Mariana Ferreira Mariana Mangas Paula Neves Rita Sapage Rui Coelho Teresa Caridade Teresa Tavares

3. Introduction to GERD Research Question and Aim Methods Study Design Papers Selection: Queries Number of Abstracts Inclusion/Exclusion Criteria Fluxogram Data to be extracted: Variables Quality assessment Statistical treatment

4. Prevalent and chronic condition Reflux of the stomach contents into the oesophagus Troublesome symptoms - heartburn - acid regurgitation Complications - haemorrhage, stricture, - Barrett’s oesophagus - adenocarcinoma of the distal oesophagus 35% of Portuguese adults refer GERD symptoms Adapted from: Maria João Branco, Paulo Nogueira, Teresa Contreiras. Uma observação sobre estimativas da prevalência de algumas doenças crónicas, em Portugal Continental. Julho 2005, Observatório Nacional de Saúde, Instituto Dr. Ricardo Jorge.

5. mainstay of medical therapy in GERD; heals esophageal mucosal injury; highly selective and effective in their action and have few short- or long-term adverse effects. Omeprazole, Lanzoprazole Pantoprazole, Raberprazole Pettit M (2005). Treatment of gastroesophageal reflux disease. Pharm World Sci. 27 (6):432-5.

6. New - generation PPI; efficacy and safety were reviewed and causes of failure were discussed; Several studies have shown marginal differences in efficacy between various PPIs regimens. Glatzel D et al (2006). Pantoprazole 40 mg is as effective as esomeprazole 40 mg to relieve symptoms of gastroesophageal reflux disease after 4 weeks of treatment and superior regarding the prevention of symptomatic relapse. Digestion. 74(3-4):145-54.

7. Introduction to GERD Research Question and Aim Methods Study Design Papers Selection: Queries Number of Abstracts Inclusion/Exclusion Criteria Fluxogram Data to be extracted: Variables Quality assessment Statistical treatment

8.  Is esomeprazole more effective in enduring symptom relief and in healing mucosal injury, relatively to omeprazole, lansoprazole, rabeprazole, pantoprazole, in GERD patients?

9.  To compare efficacy of esomeprazole relatively to the other PPIs, in GERD patients, in  symptoms relief  inducing mucosal healing

10. Introduction to GERD Research Question and Aim Methods Study Design Papers Selection: Queries Number of Abstracts Inclusion/Exclusion Criteria Fluxogram Data to be extracted: Variables Quality assessment Statistical treatment

11.  Synthesis’ studies: Sistematic review Metanalysis study  Bibliographic databases: Medline (http://www.nlm.nih.gov/medlineplus/) Scopus (http://www.scopus.com) ISI Web of Knowledge (http://isiwebofknowledge.com/)

12. (gastroesophageal reflux OR "Gastroesophageal Reflux"[Mesh] OR GERD OR NERD OR non-esophagitis reflux disease OR esophagitis) AND (regurgitation OR heartburn) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract])) AND (omeprazole OR "Omeprazole"[Mesh] OR pantoprazole OR "pantoprazole"[Substance Name] OR rabeprazole OR "rabeprazole"[Substance Name] OR lansoprazole OR "lansoprazole"[Substance Name]) AND (esomeprazole OR "Omeprazole"[Mesh]) NOT (”Barrett esophagus” [Mesh]) 158 articles

13. ((gastroesophageal reflux OR GERD OR NERD OR non-esophagitis reflux disease OR esophagitis) AND (regurgitation OR heartburn) AND (omeprazole OR pantoprazole OR rabeprazole OR lansoprazole) AND (esomeprazole) NOT (Barrett Syndrome)) 35 articles

14. ((gastroesophageal reflux OR gerd OR nerd OR non-esophagitis reflux disease OR esophagitis) AND (regurgitation OR heartbun) AND NOT (barrett syndrome)) AND (omeprazole OR pantoprazole OR rabeprazole OR lansoprazole) AND (esomeprazole) AND (EXCLUDE(DOCTYPE, "re") OR EXCLUDE(DOCTYPE, "cp")) 57 articles

15. ISI PUBMED SCOPUS 12 7 8 15 30 143 N=215

16. Studies in Humans; Studies in adults (19 - 75 years old); Clinical trials; Original articles; Treatment of patients only with PPIs;

17. Inaccessibility of data; Articles published from December of 2007; Studies in pregnant; Studies in people with other illnesses beyond GERD;

18. Start 250 articles found

19. 35 articles excluded No Yes 215 articles included

20. Do the two reviewers includ the article? No Yes 100 articles included Select articles according to inclusion and exclusion criteria Yes No The two reviewers discuss End

21. Data to collect : number of participants; number of participants who had abandoned the study Intention to treat age and gender; ethnia; GERD (NERD vs Esophagitis) which PPI was esomeprazole compared against; dose of esomeprazole (20 or 40mg) and other;

22. time of intervention (in weeks) time to outcome primary aim (esomeprazole vs other) mucosal healing (assessment) symptoms relief habits of the participants (ex. smoking) physiological state (ex. menopause)

23. Methods: Data to be Extracted - Quality assessment CONSORT - Consolidated Standards of Reporting Trials QUOROM - Guidelines for Meta-Analyses and Systematic Reviews of RCTs

24. SPSS and specific software for metanalysis (eg.: RevMan) Methods: Data to be Extracted - Statistical treatment

25. If Esomeprazole is: more effective in symptom relief; healing and prevention of mucosal injury; than old PPIs.

26. Class 1 6 1 st Year Introdução à Medicina I FMUP