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[Prevention of NSAID induced gastroduodenal ulcers].
Ugeskr Laeger. 2001 Oct 29; 163(44):6103-5.UL

Abstract

BACKGROUND

Non-steroidal anti-inflammatory drugs (NSAIDs) are important agents in the management of arthritic and inflammatory conditions, and are among the most frequently prescribed medications in North America and Europe. However, there is overwhelming evidence linking these agents to a variety of gastrointestinal (GI) toxicities.

OBJECTIVES

To review the effectiveness of common interventions for the prevention of NSAID induced upper GI toxicity.

SEARCH STRATEGY

A literature search was conducted, according to the Cochrane methodology for identification of randomized controlled trials in electronic databases, including MEDLINE from 1966 to January 2000, Current Contents for 6 months prior to January 2000, Embase to February 1999, and a search of the Cochrane Controlled Trials Register from 1973 to 1999. Recent conference proceedings were reviewed and content experts and companies were contacted.

SELECTION CRITERIA

Randomized controlled clinical trials (RCTs) of prostaglandin analogues (PA), H2-receptor antagonists (H2RA) or proton pump inhibitors (PPI) for the prevention of chronic NSAID induced upper Gl toxicity were included.

DATA COLLECTION AND ANALYSIS

Two independent reviewers extracted data regarding population characteristics, study design, methodological quality and number of patients with endoscopic ulcers, ulcer complications, symptoms, overall drop-outs, drop-outs due to symptoms. Dichotomous data was pooled using Revman V3.1. Heterogeneity was evaluated using a chi square test.

MAIN RESULTS

Thirty-three RCTs met the inclusion criteria. All doses of misoprostol significantly reduced the risk of endoscopic ulcers. Misoprostol 800 micrograms/day was superior to 400 micrograms/day for the prevention of endoscopic gastric ulcers (RR = 0.18, and RR = 0.38 respectively, p = 0.0055). A dose response relationship was not seen with duodenal ulcers. Misoprostol caused diarrhea at all doses, although significantly more at 800 micrograms/day than 400 micrograms/day (p = 0.0012). Misoprostol was the only prophylactic agent documented to reduce ulcer complications. Standard doses of H2RAs were effective at reducing the risk of endoscopic duodenal (RR = 0.24; 95%, CI: 0.10-0.57) but not gastric ulcers (RR = 0.73; 95% CI: 0.50-1.09). Both double dose H2RAs and PPIs were effective at reducing the risk of endoscopic duodenal and gastric ulcers (RR = 0.44; 95% CI: 0.26-0.74 and RR = 0.37; 95% CI: 27-0.51 respectively for gastric ulcer), and were better tolerated than misoprostol.

REVIEWERS' CONCLUSIONS

Misoprostol, PPIs, and double dose H2RAs are effective at preventing chronic NSAID related endoscopic gastric and duodenal ulcers. Lower doses of misoprostol are less effective and are still associated with diarrhea. Only misoprostol 800 micrograms/day has been directly shown to reduce the risk of ulcer complications.

Authors+Show Affiliations

Medicinsk afdeling M, gastroenterologisk sektion, Amtssygehuset i Glostrup.No affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

dan

PubMed ID

11715151

Citation

Hansen, J M., and P Bytzer. "[Prevention of NSAID Induced Gastroduodenal Ulcers]." Ugeskrift for Laeger, vol. 163, no. 44, 2001, pp. 6103-5.
Hansen JM, Bytzer P. [Prevention of NSAID induced gastroduodenal ulcers]. Ugeskr Laeger. 2001;163(44):6103-5.
Hansen, J. M., & Bytzer, P. (2001). [Prevention of NSAID induced gastroduodenal ulcers]. Ugeskrift for Laeger, 163(44), 6103-5.
Hansen JM, Bytzer P. [Prevention of NSAID Induced Gastroduodenal Ulcers]. Ugeskr Laeger. 2001 Oct 29;163(44):6103-5. PubMed PMID: 11715151.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Prevention of NSAID induced gastroduodenal ulcers]. AU - Hansen,J M, AU - Bytzer,P, PY - 2001/11/22/pubmed PY - 2002/1/5/medline PY - 2001/11/22/entrez SP - 6103 EP - 5 JF - Ugeskrift for laeger JO - Ugeskr Laeger VL - 163 IS - 44 N2 - BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are important agents in the management of arthritic and inflammatory conditions, and are among the most frequently prescribed medications in North America and Europe. However, there is overwhelming evidence linking these agents to a variety of gastrointestinal (GI) toxicities. OBJECTIVES: To review the effectiveness of common interventions for the prevention of NSAID induced upper GI toxicity. SEARCH STRATEGY: A literature search was conducted, according to the Cochrane methodology for identification of randomized controlled trials in electronic databases, including MEDLINE from 1966 to January 2000, Current Contents for 6 months prior to January 2000, Embase to February 1999, and a search of the Cochrane Controlled Trials Register from 1973 to 1999. Recent conference proceedings were reviewed and content experts and companies were contacted. SELECTION CRITERIA: Randomized controlled clinical trials (RCTs) of prostaglandin analogues (PA), H2-receptor antagonists (H2RA) or proton pump inhibitors (PPI) for the prevention of chronic NSAID induced upper Gl toxicity were included. DATA COLLECTION AND ANALYSIS: Two independent reviewers extracted data regarding population characteristics, study design, methodological quality and number of patients with endoscopic ulcers, ulcer complications, symptoms, overall drop-outs, drop-outs due to symptoms. Dichotomous data was pooled using Revman V3.1. Heterogeneity was evaluated using a chi square test. MAIN RESULTS: Thirty-three RCTs met the inclusion criteria. All doses of misoprostol significantly reduced the risk of endoscopic ulcers. Misoprostol 800 micrograms/day was superior to 400 micrograms/day for the prevention of endoscopic gastric ulcers (RR = 0.18, and RR = 0.38 respectively, p = 0.0055). A dose response relationship was not seen with duodenal ulcers. Misoprostol caused diarrhea at all doses, although significantly more at 800 micrograms/day than 400 micrograms/day (p = 0.0012). Misoprostol was the only prophylactic agent documented to reduce ulcer complications. Standard doses of H2RAs were effective at reducing the risk of endoscopic duodenal (RR = 0.24; 95%, CI: 0.10-0.57) but not gastric ulcers (RR = 0.73; 95% CI: 0.50-1.09). Both double dose H2RAs and PPIs were effective at reducing the risk of endoscopic duodenal and gastric ulcers (RR = 0.44; 95% CI: 0.26-0.74 and RR = 0.37; 95% CI: 27-0.51 respectively for gastric ulcer), and were better tolerated than misoprostol. REVIEWERS' CONCLUSIONS: Misoprostol, PPIs, and double dose H2RAs are effective at preventing chronic NSAID related endoscopic gastric and duodenal ulcers. Lower doses of misoprostol are less effective and are still associated with diarrhea. Only misoprostol 800 micrograms/day has been directly shown to reduce the risk of ulcer complications. SN - 0041-5782 UR - https://www.unboundmedicine.com/medline/citation/11715151/[Prevention_of_NSAID_induced_gastroduodenal_ulcers]_ DB - PRIME DP - Unbound Medicine ER -