Treatment of non-ulcer dyspepsia:: a meta-analysis of placebo-controlled prospective studies

Background: Dyspeptic symptoms are commonly reported complaints in clinical practice and are mostly the result of functional disorders. Empirical treatment with histamine H-2-receptor blockers or gastroprokinetics for 2-4 weeks has frequently been proposed as first line management of these patients. The clinical trials which support the use of these agents, show a high variation in clinical success rate and benefit of these treatments. Methods: The available clinical trials were evaluated, pooled where appropriate and subjected to a meta-analysis with the principal goal to provide valid treatment recommendations for patients with non-ulcer dyspepsia. In the present meta-analysis 19 studies on gastroprokinetics (cisapride, domperidone) and 10 studies on histamine H-2-receptor antagonists (cimetidine, ranitidine) were included. Results: Based on these studies, a total of 1540 patients were evaluated for histamine H-2-receptor antagonists (verum n = 786, placebo n = 754) and 1235 patients for gastroprokinetics (verum n = 616, placebo n = 619). The probability for treatment success compared to placebo was 0.2026 (0.1261; 0.2791) for histamine H-2-receptor antagonists and 0.4029 (0.3042; 0.5069) for gastroprokinetics. Conclusions: Based on these data both treatments are significantly more effective than placebo in the symptomatic treatment of non-ulcer dyspepsia, with gastroprokinetics (cisapride, domperidone) being more effective than histamine H-2-receptor antagonists (cimetidine, ranitidine).