PMID- 11715151
OWN - NLM
STAT- MEDLINE
DCOM- 20011214
LR  - 20131121
IS  - 0041-5782 (Print)
IS  - 0041-5782 (Linking)
VI  - 163
IP  - 44
DP  - 2001 Oct 29
TI  - [Prevention of NSAID induced gastroduodenal ulcers].
PG  - 6103-5
AB  - 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.
FAU - Hansen, J M
AU  - Hansen JM
AD  - Medicinsk afdeling M, gastroenterologisk sektion, Amtssygehuset i Glostrup.
FAU - Bytzer, P
AU  - Bytzer P
LA  - dan
PT  - English Abstract
PT  - Journal Article
TT  - Forebyggelse af NSAID-inducerede gastroduodenale ulcerationer.
PL  - Denmark
TA  - Ugeskr Laeger
JT  - Ugeskrift for laeger
JID - 0141730
RN  - 0 (Antacids)
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0E43V0BB57 (Misoprostol)
SB  - IM
MH  - Antacids/administration & dosage
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects
MH  - Anti-Ulcer Agents/*administration & dosage
MH  - Duodenal Ulcer/chemically induced/*prevention & control
MH  - Evidence-Based Medicine
MH  - Histamine H2 Antagonists/administration & dosage
MH  - Humans
MH  - Meta-Analysis as Topic
MH  - Misoprostol/administration & dosage
MH  - Stomach Ulcer/chemically induced/*prevention & control
EDAT- 2001/11/22 10:00
MHDA- 2002/01/05 10:01
CRDT- 2001/11/22 10:00
PHST- 2001/11/22 10:00 [pubmed]
PHST- 2002/01/05 10:01 [medline]
PHST- 2001/11/22 10:00 [entrez]
PST - ppublish
SO  - Ugeskr Laeger. 2001 Oct 29;163(44):6103-5.