PMID- 11575445
OWN - NLM
STAT- MEDLINE
DCOM- 20011018
LR  - 20190721
IS  - 0163-2116 (Print)
IS  - 0163-2116 (Linking)
VI  - 46
IP  - 9
DP  - 2001 Sep
TI  - Prevention of acute NSAID-related gastroduodenal damage: a meta-analysis of 
      controlled clinical trials.
PG  - 1924-36
AB  - No consensus exists as to whether cotherapy is effective in the short-term 
      prevention of severe NSAID-related gastroduodenal damage. The aim of this study 
      was to provide a quantitative systematic review of the efficacy of 
      gastroprotective drugs, such as misoprostol, H2-blockers, and proton pump 
      inhibitors (PPI) in preventing the severe acute NSAID-related gastroduodenal 
      damage. Placebo-controlled randomized clinical trials on the use of misoprostol, 
      H2-blockers, and PPIs as preventative agents published between January 1986 and 
      May 1999 were identified through Medline and reference lists from clinical 
      reviews. Studies on patients or healthy subjects were considered to be eligible 
      for data pooling if they were performed in acute NSAID users (not longer than 30 
      days) and with at least one endoscopic evaluation during therapy that reported 
      results specifically for gastric and duodenal damage. Risk difference (RD), 
      heterogeneity chi2 test, publication bias assessment and number needed to treat 
      (NnT) were calculated for each meta-analysis by a customized program. Twenty-one 
      trials met the inclusion criteria evaluating a total of 636 healthy subjects and 
      1904 patients with arthritis randomized to active drug or placebo. The baseline 
      risk of NSAID-related gastric (68% vs 16.6%, P < 0.001) and duodenal (22% vs 
      8.5%, P < 0.001) damage was higher in healthy subjects compared to patients with 
      arthritis. Meta-analysis demonstrated a significant heterogeneity between trials 
      performed in the two populations (P < 0.0001). In healthy subjects the active 
      drug treatment induced a significant prevention of severe gastric (misoprostol RD 
      = 69%, 95% CI = 60.3-77.7, H2-blocker RD = 38.3%, 95% CI = 17.8-58.9 and PPI RD = 
      43%, 95% CI = 28.2-57.7) and duodenal damage (misoprostol RD = 22.3%, 95% CI = 
      13.6-31, H2-blocker RD = 13.2%, 95% CI = 5.2-21.3 and PPI RD = 17.7%, 95% CI = 
      3.5-31.8). NnT values were, respectively, 1, 3, and 2 for gastric and 4, 8, and 6 
      for duodenal damage. In patients with arthritis lower RD and higher NnT values 
      were found compared to healthy subjects. In conclusions, cotreatment with 
      gastroprotective drugs for short-term prevention of severe gastroduodenal 
      NSAID-related damage was more effective in healthy subjects than in patients with 
      arthritis; misoprostol and PPIs were more effective than H2-blockers in the 
      prevention of both gastric and duodenal severe damage; more studies need to 
      evaluate the role of short-term prevention in patients with arthritis who require 
      acute NSAID treatment.
FAU - Leandro, G
AU  - Leandro G
AD  - Gastroenterological Hospital S. De Bellis, IRCCS, Castellana Grotte (BA), Italy.
FAU - Pilotto, A
AU  - Pilotto A
FAU - Franceschi, M
AU  - Franceschi M
FAU - Bertin, T
AU  - Bertin T
FAU - Lichino, E
AU  - Lichino E
FAU - Di Mario, F
AU  - Di Mario F
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0E43V0BB57 (Misoprostol)
SB  - IM
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/therapeutic use
MH  - Anti-Ulcer Agents/*therapeutic use
MH  - Arthritis/drug therapy
MH  - Controlled Clinical Trials as Topic
MH  - Duodenum/*drug effects
MH  - Histamine H2 Antagonists/*therapeutic use
MH  - Humans
MH  - Misoprostol/*therapeutic use
MH  - *Proton Pump Inhibitors
MH  - Stomach/*drug effects
EDAT- 2001/09/29 10:00
MHDA- 2001/10/19 10:01
CRDT- 2001/09/29 10:00
PHST- 2001/09/29 10:00 [pubmed]
PHST- 2001/10/19 10:01 [medline]
PHST- 2001/09/29 10:00 [entrez]
AID - 10.1023/a:1010687115298 [doi]
PST - ppublish
SO  - Dig Dis Sci. 2001 Sep;46(9):1924-36. doi: 10.1023/a:1010687115298.