Revisão sistemática e metanálise do uso de procinéticos no refluxo gastroesofágico e na doença do refluxo gastroesofágico em Pediatria

• Autor(a) principal: Magalhães, Pedro Vieira S.
• Data de Publicação: 2009
• Outros Autores: Bastos, Telma Regina P. D., Appolinário, José Carlos B., Bacaltchuk, Josué [UNIFESP], Mota Neto, Joaquim Ignácio S.
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0103-05822009000300002; http://repositorio.unifesp.br/handle/11600/5226
• topic: meta-analysis; gastroesophageal reflux; metoclopramide; domperidone; bethanechol; Pediatrics; metanálise; refluxo gastroesofágico; metoclopramida; domperidona; betanecol; Pediatria

OBJECTIVE: To evaluate, by systematic review and meta-analysis, randomized studies comparing the prokinetics (domperidone, bromopride, metoclopramide and bethanechol) to placebo in the treatment of gastroesophagic reflux (GER) and gastroesophagic reflux disease (GERD) in children. METHODS: Bibliographic search for randomized clinical trials (Medline, EMBASE, Biological Abstracts, ISI/Web of Science, CINAHL, Lilacs e Cochrane). The primary outcome was the modification of reflux symptoms. Other outcomes were: GER-related complications, alterations in control exams, life quality, adverse events and abandon of treatment. RESULTS: The metanalysis included four studies on domperidone, two on metoclopramide, and one on bethanechol. No study of bromopride was retrieved. The risk of non-response to the treatment was significantly smaller in children that received prokinetics in comparison to placebo (RR 0.35, 95%CI 0.14-0.88). Individual therapeutic advantage regarding placebo was related to domperidone (n=126; RR 0.27; 95%CI 0.14-0.52, NNT 3; I2 0%) and bethanechol (n=44; RR 0.19; 95%CI 0.05-0.55; NNT 2), but not to metoclopramide (n=71; RR 0.63; 95%CI 0.07-5.71; I2 92.2%). CONCLUSIONS: The evidence for prokinetic use in GER and GERD in children is limited because the few studies report preliminary trials that evaluate short-term responses and show methodological limitations.