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Prevention of nonsteroidal anti-inflammatory drug-induced gastrointestinal mucosal injury. A meta-analysis of randomized controlled clinical trials.
Arch Intern Med. 1996 Nov 11; 156(20):2321-32.AI

Abstract

BACKGROUND

The policy of prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal mucosal injury is still a matter of discussion. Indeed, no consensus exists as to whether cotherapy with histamine type 2 (H2) blockers or misoprostol is cost-effective.

METHODS

Placebo-controlled randomized clinical trials on the use of H2 blockers or misoprostol, as preventive agents (published between) January 1970 and December 1994), were identified through MEDLINE and reference lists from literature reviews. Crude rates of endoscopic lesions with short-term (< 2 weeks) and long-term (> 4 weeks) NSAID treatment were systematically assessed by 3 independent observers based on the intention-to-treat principle. The method of DerSimonian and Laird was used for pooling data. Heterogeneity was evaluated by using the Q statistic and the plots described by L'Abbe and colleagues.

RESULTS

Twenty-four trials met the criteria for entry into the study. Gastric ulcer was found to be significantly reduced by misoprostol-both in short-term (pooled rate difference [RD], -13%, 95% confidence interval [CI], -26% to -1%) and long-term (RD, -8%; 95% CI, -18% to -1%) NSAID treatment-but not by H2 blockers. The risk for duodenal ulcer was significantly reduced by H2 blockers (RD, -2%; 95% CI, -5% to -0.2%) and by misoprostol (RD, -3%; 95% CI, -6% to -0.1%) in long-term but not in short-term administration.

CONCLUSIONS

The use of misoprostol, but no that of H2 blockers, was beneficial in the prevention of NSAID-induced gastric ulcers. The number of patients to be treated to prevent 1 gastric ulcer with short- and long-term NSAID treatment is 11 and 15, respectively, for an intermediate baseline risk of 10%. Misoprostol and H2 blockers were beneficial in the long-term prevention of duodenal ulcers; misoprostol or H2 blockers in the short-term prevention of duodenal ulcers remains to be confirmed.

Authors+Show Affiliations

Department of Digestive Diseases and Nutrition, General Hospital San Filippo Neri, Rome, Italy.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

8911239

Citation

Koch, M, et al. "Prevention of Nonsteroidal Anti-inflammatory Drug-induced Gastrointestinal Mucosal Injury. a Meta-analysis of Randomized Controlled Clinical Trials." Archives of Internal Medicine, vol. 156, no. 20, 1996, pp. 2321-32.
Koch M, Dezi A, Ferrario F, et al. Prevention of nonsteroidal anti-inflammatory drug-induced gastrointestinal mucosal injury. A meta-analysis of randomized controlled clinical trials. Arch Intern Med. 1996;156(20):2321-32.
Koch, M., Dezi, A., Ferrario, F., & Capurso, I. (1996). Prevention of nonsteroidal anti-inflammatory drug-induced gastrointestinal mucosal injury. A meta-analysis of randomized controlled clinical trials. Archives of Internal Medicine, 156(20), 2321-32.
Koch M, et al. Prevention of Nonsteroidal Anti-inflammatory Drug-induced Gastrointestinal Mucosal Injury. a Meta-analysis of Randomized Controlled Clinical Trials. Arch Intern Med. 1996 Nov 11;156(20):2321-32. PubMed PMID: 8911239.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention of nonsteroidal anti-inflammatory drug-induced gastrointestinal mucosal injury. A meta-analysis of randomized controlled clinical trials. AU - Koch,M, AU - Dezi,A, AU - Ferrario,F, AU - Capurso,I, PY - 1996/11/11/pubmed PY - 1996/11/11/medline PY - 1996/11/11/entrez SP - 2321 EP - 32 JF - Archives of internal medicine JO - Arch Intern Med VL - 156 IS - 20 N2 - BACKGROUND: The policy of prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal mucosal injury is still a matter of discussion. Indeed, no consensus exists as to whether cotherapy with histamine type 2 (H2) blockers or misoprostol is cost-effective. METHODS: Placebo-controlled randomized clinical trials on the use of H2 blockers or misoprostol, as preventive agents (published between) January 1970 and December 1994), were identified through MEDLINE and reference lists from literature reviews. Crude rates of endoscopic lesions with short-term (< 2 weeks) and long-term (> 4 weeks) NSAID treatment were systematically assessed by 3 independent observers based on the intention-to-treat principle. The method of DerSimonian and Laird was used for pooling data. Heterogeneity was evaluated by using the Q statistic and the plots described by L'Abbe and colleagues. RESULTS: Twenty-four trials met the criteria for entry into the study. Gastric ulcer was found to be significantly reduced by misoprostol-both in short-term (pooled rate difference [RD], -13%, 95% confidence interval [CI], -26% to -1%) and long-term (RD, -8%; 95% CI, -18% to -1%) NSAID treatment-but not by H2 blockers. The risk for duodenal ulcer was significantly reduced by H2 blockers (RD, -2%; 95% CI, -5% to -0.2%) and by misoprostol (RD, -3%; 95% CI, -6% to -0.1%) in long-term but not in short-term administration. CONCLUSIONS: The use of misoprostol, but no that of H2 blockers, was beneficial in the prevention of NSAID-induced gastric ulcers. The number of patients to be treated to prevent 1 gastric ulcer with short- and long-term NSAID treatment is 11 and 15, respectively, for an intermediate baseline risk of 10%. Misoprostol and H2 blockers were beneficial in the long-term prevention of duodenal ulcers; misoprostol or H2 blockers in the short-term prevention of duodenal ulcers remains to be confirmed. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/8911239/Prevention_of_nonsteroidal_anti_inflammatory_drug_induced_gastrointestinal_mucosal_injury__A_meta_analysis_of_randomized_controlled_clinical_trials_ DB - PRIME DP - Unbound Medicine ER -