PMID- 10990235
OWN - NLM
STAT- MEDLINE
DCOM- 20010125
LR  - 20071115
IS  - 0315-162X (Print)
IS  - 0315-162X (Linking)
VI  - 27
IP  - 9
DP  - 2000 Sep
TI  - The prevention of chronic NSAID induced upper gastrointestinal toxicity: a 
      Cochrane collaboration metaanalysis of randomized controlled trials.
PG  - 2203-14
AB  - OBJECTIVE: To review the effectiveness of common interventions for the prevention 
      of nonsteroidal antiinflammatory drug (NSAID) induced upper gastrointestinal (GI) 
      toxicity. METHODS: Randomized controlled clinical trials (RCT) of prostaglandin 
      analogs, H2-receptor antagonists (H2RA), or proton pump inhibitors (PPI) for the 
      prevention of chronic NSAID induced upper GI toxicity were identified through 
      electronic databases, the Cochrane control trials register, conference 
      proceedings, and by contacting content experts and companies. Outcome measures 
      investigated were endoscopic ulcers, ulcer complications, symptoms, overall 
      dropouts, dropouts due to symptoms, and study quality. RESULTS: Thirty-four RCT 
      met the inclusion criteria. All doses of misoprostol significantly reduced the 
      risk of endoscopic ulcers. Misoprostol 800 microg/day was superior to 400 
      microg/day for the prevention of endoscopic gastric ulcers (RR 0.18, 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 than 400 microg/day (p = 0.0012). Misoprostol was the only 
      prophylactic agent documented to reduce ulcer complications. Standard doses of 
      H2RA 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 
      H2RA and PPI 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 0.27-0.51, 
      respectively, for gastric ulcer) and were better tolerated than misoprostol. 
      CONCLUSION: Misoprostol, PPI, and double dose H2RA are effective in 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 microg/day has been directly shown to reduce the risk of ulcer 
      complications.
FAU - Rostom, A
AU  - Rostom A
AD  - Department of Medicine, University of Ottawa, Ontario, Canada. 
      alrostom@sympatico.ca
FAU - Wells, G
AU  - Wells G
FAU - Tugwell, P
AU  - Tugwell P
FAU - Welch, V
AU  - Welch V
FAU - Dube, C
AU  - Dube C
FAU - McGowan, J
AU  - McGowan J
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - Canada
TA  - J Rheumatol
JT  - The Journal of rheumatology
JID - 7501984
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Prostaglandins, Synthetic)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anti-Inflammatory Agents, Non-Steroidal/*toxicity
MH  - Anti-Ulcer Agents/*administration & dosage/adverse effects
MH  - Digestive System/*drug effects
MH  - Histamine H2 Antagonists/administration & dosage
MH  - Humans
MH  - Middle Aged
MH  - Peptic Ulcer/*drug therapy/*prevention & control
MH  - Prostaglandins, Synthetic/administration & dosage
MH  - Randomized Controlled Trials as Topic/*statistics & numerical data
EDAT- 2000/09/16 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/09/16 11:00
PHST- 2000/09/16 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/09/16 11:00 [entrez]
PST - ppublish
SO  - J Rheumatol. 2000 Sep;27(9):2203-14.