Efficacy of H pylori eradication: 156 clinical trials were included (275 treatment arms; 17,000 patients).
Short-term healing of GORD: 9 RCTs compared omeprazole with other drugs including ranitidine, cisapride, lansoprazole and pantoprazole.
Long-term treatment of GORD: 2 RCTs compared omeprazole with placebo (N = 358 patients); 5 RCTs compared omeprazole with cisapride or ranitidine or lansoprazole (N = 1876 patients).
Symptomatic gastro-oesophageal reflux disease with or without oesophagitis: short-term defined as 4 to 8 weeks: 3 RCTs compared omeprazole with placebo (N = 1256 patients); 1 RCT compared omeprazole with cisapride (N = 726 patients); long term defined as 6 months: 2 RCTs compared omeprazole with placebo (N > 495 patients); 1 RCT compared omeprazole with placebo (N = 156 patients).
Omeprazole in patients receiving ongoing therapy with non steroidal anti-inflammatory drugs: 2 RCTs compared omeprazole with ranitidine or misoprostol (N = 1456 patients).
Eradication of H. Pylori: study design features such as randomisation, blinding and patient numbers had little effect on overall results.
Median eradication rates by treatment regime: triple therapy regimes containing omeprazole plus 2 antibacterial agents (86%); quadruple therapy (80%); triple therapy with omeprazole plus bismuth plus single antibacterial agent (78%); dual therapy (58%).
Median eradication rates for triple therapy by duration of therapy: 7 days (85%); 10 days (91%); 14 days (87%); 14 days (87%); 4 weeks (81%); all other durations (78%).
Median eradication rates of triple regimes of duration 7, 10 or 14 days by dose of omeprazole: omeprazole 40 mg/day in 1 or 2 divided doses (86% or 88%); 20 mg daily (82%).
Median eradication rates of triple regimes for 7-14 days with omeprazole 40 mg/day by antibiotic combination: amoxycillin plus clarithromycin (86%); clarithromycin plus metronidazole (88%); amoxycillin plus metronidazole (86%); or clarithromycin plus tinidazole (89%).
Median eradication rates in children with H pylori: most trials were non comparative, and did not report blinding. Reports of comparative trials did not state whether randomisation took place and did not report any statistical analysis of results. Triple therapy containing omeprazole (68% to 93%); omeprazole plus amoxycillin for 2 weeks (16% to 20%).
Short-term erosion healing in GORD: authors report that results from 2 meta-analysis suggests that omeprazole is superior in erosion-healing ability to H2 antagonists, cisapride, sucralfate and placebo. However there is no evaluation of the validity of these reviews. No effect size estimated for individual trials in this review. Presented data suggests that omeprazole is more effective than ranitidine (55% to 94% vs 25% to 92%). Endoscopically confirmed oesophagitis relapse rates after 12 months prophylaxis: no effect size estimated for individual trials in this review. Presented results for relapse rates suggest that 20 mg/day omeprazole is more effective than placebo, ranitidine, and cisapride. Omeprazole (20 mg/day) and lansoprazole (30 mg/day) appear to have similar effects (relapse rates 9% to 14%).
Incidence of remission defined as no ulcer, <= 10 erosions, and at most mild dyspeptic symptoms in patients requiring on-going treatment with NSAI drugs (over 3 to 6 months): incidence ranges estimated from graph as follows: omeprazole (0.05% to 3%); misoprostol (10%); placebo (4% to 12%). Healing of NSAI gastrointestinal damage (8 weeks treatment): data suggests that omeprazole 20 mg/day is more effective than misoprostol (87% to 93 % vs 73% to 73% to 77%)or ranitidine (84% to 92% vs 64% to 81%) in gastric or duodenal ulcer healing, and more effective than ranitidine (98% vs 77%) but less effective than misoprostol (89% vs 77%) in healing of erosions. Adverse effects: the authors report that most adverse events occurring during treatment with omeprazole are mild, self-limiting, and unrelated to dosage or patient age. The most common side-effects (occurring in between 1% and 2.5% of patients) are gastrointestinal events. No evidence is presented.