Drugs for reducing stomach acid for people with cystic fibrosis

Ng SM, Francini AJ

Published Online:

June 16, 2010

Cystic fibrosis causes damage to the lungs and to the pancreas. The pancreas produces digestive enzymes which are needed for the body to absorb food. If the pancreas is damaged this can affect how you can absorb food. It can also increase acidity in the stomach, which may lead to heartburn and peptic ulcers. There are drugs that can reduce the amount of acid in the stomach. Trials of these drugs have shown that they can improve problems in the stomach and digestive system and in the absorption of fat. The review looked at 16 trials with a total of 256 children and adults. We were unable to combine the results from these trials due to their design. Individual trials reported some improvements in abdominal pain and fat absorption. However, the trials did not report improvements for other issues such as lung function, quality of life, or survival. The different drugs studied caused some adverse events; mainly diarrhoea (two people withdrew from one trial because of this) and bloating due to wind. There were few trials included in the review whose quality was not well reported. The results from these trials could not be combined and so did not allow us to reach firm conclusions about whether people with cystic fibrosis would benefit from taking these drugs. New long-term trials are needed to examine the benefits and possible adverse effects for people with cystic fibrosis taking these drugs.

Abstract (click to read)

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 strategy:

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: 14 April 2010.

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.

This record should be cited as:

Ng SM, Francini AJ. Drug therapies for reducing gastric acidity in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003424. DOI: 10.1002/14651858.CD003424

Assessed as up to date:

May 12, 2010

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Primary Review Group:

Cystic Fibrosis and Genetic Disorders Group

Health topics:

Gastroenterology > Cystic fibrosis > Treatment: gastrointestinal

Genetic disorders > Cystic fibrosis > Gastrointestinal therapy

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Drugs for reducing stomach acid for people with cystic fibrosis

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