Pemberian Proton Pump Inhibitor Dibandingkan dengan Antagonis Reseptor-H2 pada Anak dengan Penyakit Refluks Gastrointestinal
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Latar belakang. Pada umumnya anak dengan penyakit gastroesofageal refluks (PRGE) diterapi dengan antagonis reseptor H2 (H2RA) atau inhibitor pompa proton (PPI). Keduanya merupakan obat yang tersering diresepkan pada PRGE anak, namun efikasi keduanya masih kontroversi.
Tujuan. Untuk mengevaluasi penggunaan PPI dan H2RA pada anak dengan PRGE melalui telaah sajian kasus berbasis bukti.
Metode. Pencarian literatur secara sistematik menggunakan instrumen pencari PUBMED, Cochrane, dan Google Scholar. Pencarian dibatasi pada literatur berbahasa Inggris, yang dipublikasi selama 15 tahun terakhir, dan usia pasien 0–18 tahun. Studi dianggap memenuhi syarat bila dilakukan secara randomized-controlled trials, mengevaluasi PPI dan/atau H2RA untuk pengobatan GERD anak. Studi yang hanya berupa abstrak, yang hanya mengevaluasi selain non-klinis, dan laporan kasus diekslusi.
Hasil. Studi kohort oleh Ruigomez dkk mencakup 8172 pasien dengan PPI (24 pasien dengan esomeprazole dan 8148 pasien dengan PPI lainnya) dan 7905 dengan H2RA. Karakteristik dasar keduanya serupa, namun anak dengan PPI cenderung lebih tua usianya. Luaran terkait keselamatan sebanyak 92 hanya pada PPI selain esomeprazole. Mattos dkk memperoleh 735 literatur, 23 studi (1598 pasien yang dirandomisasi) yang diikutsertakan dalam review sistematik. Delapan studi membuktikan bahwa PPI dan H2RA cukup efektif mengatasi manifestasi tipikal GERD. Studi lain menunjukkan bahwa omeprazole lebih unggul dibandingkan rantidin dalam pengobatan manifestasi refluks ekstra esofageal.
Kesimpulan. Inhibitor pompa proton (PPI) atau H2RA dapat digunakan untuk pengobatan GERD pada anak. Omeprazol lebih unggul dibandingkan ranitidine pada pengobatan manifestasi refluks ekstra esophageal.
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DOI: http://dx.doi.org/10.14238/sp20.6.2019.382-91
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