Evaluation Of The Effectiveness Of Proton Pump Inhibitors In The Treatment Of Gastroesophageal Reflux Asthma And Its Safety In Renal Transplant Patients

OBJECTIVE: 1.The purpose of this study was to systematically evaluate the different regimens of PPI treatment for patients with gastroesophageal reflux combined with asthma,first to evaluate its effectiveness,and then to study whether PPI can improve asthma symptoms and lung function compared to placebo.In order to provide scientific rational evidence-based basis for its clinical application.2.The purpose of this study is that with the increasing use of proton pump inhibitors in kidney transplant patients,it is unclear whether the adverse effects of PPI have clinical significance in kidney transplant patients.We evaluate its safety to assess the risk of adverse reactions to PPI in renal transplant patients,provide evidence-based evidence,and guide the rational use of medicines.METHODS: 1.Study on the effectiveness of proton pump inhibitors in treating gastroesophageal reflux asthma.The method of this research is to follow the systematic review method of the International Cochrane Collaboration Network to clarify the research ideas.According to the research purpose and the inclusion / exclusion criteria of the literature,a combination of computer database search and manual search is used to find relevant literature,and then the layers are screened Qualified studies,rigorous evaluation of the ultimately included literature using Cochrane shift risk assessment tools.Extract data based on results,apply Review Manager 5.3 software for statistical analysis,perform publication bias analysis and subgroup analysis,perform qualitative and quantitative descriptions,and finally analyze the results to draw conclusions.2.Safety evaluation of proton pump inhibitors in patients with renal transplantation.The method of this research is to follow the systematic review method of the International Cochrane Collaboration Network to clarify the research ideas.According to the research purpose and the inclusion / exclusion criteria of the literature,a combination of computer database search and manual search is used to find relevant literature,and then the layers are screened Qualified studies,rigorous evaluation of the ultimately included literature using Newcastle-Ottawa scale.Extract data based on results,apply Review Manager 5.3 software for statistical analysis,perform publication bias analysis and subgroup analysis,perform qualitative and quantitative descriptions,and finally analyze the results to draw conclusions.RESULTS: 1.Study on the effectiveness of proton pump inhibitors in treating gastroesophageal reflux asthma.37 RCTs,4764 patients were included in the evaluation of the effectiveness of proton pump inhibitors in the treatment of gastroesophageal reflux asthma.The results of Meta analysis showed that: compared with not using PPI,the use of PPI(1)can reduce the score of asthma symptom [WMD=-0.43,95%CI(-0.54～-0.31)];(2)can reduce the score of gastroesophageal reflux symptoms [WMD=-0.96,95%CI(-1.31～-0.60)];(3)can improve lung function index FEV1 [WMD=0.31,95%CI(0.20～0.43)] and the percentage of FEV1 accounts for the predicted value [WMD=2.10,95%CI(1.39～2.81)];(4)can improve lung function index PEF [SMD=0.87,95%CI(0.41～1.34)];(5)can reduce percentage mutation rate of lung function index PEF % [WMD=-4.42,95%CI(-5.74～-3.10)];(6)can improve lung function Index FVC [WMD=0.19,95%CI(0.05～0.33)];(7)can improve the effective rate [RR=1.25,95%CI(1.08～1.44)] and the overall control effective rate of asthma control [RR=1.43,95% CI(1.18～1.72)].2.Safety evaluation of proton pump inhibitors in patients with renal transplantation.13 regression studies,4132 patients were included in the safety evaluation of proton pump inhibitors in renal transplant patients.The results of Meta analysis showed that: compared with not using PPI,the use of PPI(1)increased the risk of gastrointestinal reaction [RR=3.69,95%CI(1.44～9.47)];(2)increased the risk of Clostridium difficile infection [RR=2.33,95%CI(1.07～5.07)];(3)reduced serum magnesium concentration [WMD=-0.15,95%CI(-0.26～-0.04)];(4)didn’t increase the occurrence of acute rejection [RR=1.22,95%CI(0.93～1.58)];(5)didn’t affect the survival rate of patients [RR=0.99,95%CI(0.97～1.01)];(6)didn’t affect the graft failure [RR=1.24,95%CI(0.74～2.07)].CONCLUSION: 1.In patients with gastroesophageal reflux asthma,compared with not using PPI,the use of PPI can improve asthma symptoms,reduce the asthma symptom score,improve the effectiveness of asthma control and also improve lung function.Through the analysis of subgroup,we concluded that the factors which affect the efficacy of PPI include the combined use of gastric motility drugs or serotonin 4 receptor agonists,the frequency of administration,and the duration of administration.It is recommended that PPI should be used in combination with gastric motility drugs or serotonin 4 receptor agonists which given twice a day(BID)and treatment time more than 8 weeks and it can significantly improve asthma symptoms in patients with gastroesophageal reflux asthma.2.In kidney transplant patients,compared with not using PPI,the use of PPI didn’t increase the risk of acute rejection and graft failure and the survival rate of patients was not affected.While,it is necessary to pay close attention to concentration of serum magnesium to prevent hypomagnesemia and to supply magnesium in time.In addition,when using PPI,the risk of gastrointestinal adverse reactions and diarrhea caused by Clostridium difficile infection may increased.