Comparative efficacy and safety of pharmacological therapies for the healing and maintenance of erosive esophagitis: a systematic review and network meta-analysis

Erosive esophagitis is a common and clinically important complication of gastroesophageal reflux disease that can cause significant symptoms and long-term complications if inadequately treated. Pharmacological therapy is the mainstay of management, with proton pump inhibitors commonly used as first-line treatment. However, several other drug classes are available or emerging, and their relative benefits and risks across different stages of treatment remain incompletely understood. This project aims to systematically review and compare the efficacy and safety of pharmacological therapies for erosive esophagitis in adults. Using a network meta-analysis approach, the study will integrate evidence from randomized controlled trials to compare multiple drug therapies simultaneously, including established treatments and newer agents that are still under investigation. Outcomes of interest include endoscopic healing, maintenance of healing, symptom improvement, and adverse events. Healing and maintenance treatment phases will be analyzed separately to reflect their distinct clinical goals. By synthesizing all available randomized evidence within a single analytical framework, this project seeks to clarify the comparative performance of pharmacological therapies, identify evidence gaps, and support informed clinical decision-making.