PMID- 12519573
OWN - NLM
STAT- MEDLINE
DCOM- 20030221
LR  - 20220408
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 4
DP  - 2002
TI  - Prevention of NSAID-induced gastroduodenal ulcers.
PG  - CD002296
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 June 2002, Current Contents for 6 
      months prior to June 2002, EMBASE to February 2002, and a search of the Cochrane 
      Controlled Trials Register from 1973 to 2002. Biosis Previews(R), ADIS LMS Drug 
      Alerts, Pharmaceutical News Index (PNI)(R) were searched to June 2002. New 
      articles since the last search update were evaluated. 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 GI 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 
      V4.1. Heterogeneity was evaluated using a chi square test. MAIN RESULTS: Forty 
      RCTs met the inclusion criteria. All doses of misoprostol significantly reduced 
      the risk of endoscopic ulcers. Misoprostol 800 ug/day was superior to 400 ug/day 
      for the prevention of endoscopic gastric ulcers (RR=0.17, and RR=0.39 
      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 ug/day than 400 ug/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=0.36; 95% CI: 
      0.18-0.74) 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=0.40;95% CI;0.32-0.51 
      respectively for gastric ulcer), and were better tolerated than misoprostol. 
      REVIEWER'S 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 800ug/day has been directly shown to reduce the risk of ulcer 
      complications such as perforation hemorrhage or obstruction.
FAU - Rostom, A
AU  - Rostom A
AD  - University of Ottawa Department of Medicine, A1 - Endoscopy Unit, Ottawa Hospital 
      - Civic Campus, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y-4E9. 
      arostom@ottawahospital.on.ca
FAU - Dube, C
AU  - Dube C
FAU - Wells, G
AU  - Wells G
FAU - Tugwell, P
AU  - Tugwell P
FAU - Welch, V
AU  - Welch V
FAU - Jolicoeur, E
AU  - Jolicoeur E
FAU - McGowan, J
AU  - McGowan J
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
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
UOF - Cochrane Database Syst Rev. 2000;(4):CD002296. PMID: 11034748
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects
MH  - Anti-Ulcer Agents/adverse effects/*therapeutic use
MH  - Chronic Disease
MH  - Duodenal Ulcer/chemically induced/*prevention & control
MH  - Histamine H2 Antagonists/*therapeutic use
MH  - Humans
MH  - Misoprostol/adverse effects/*therapeutic use
MH  - *Proton Pump Inhibitors
MH  - Randomized Controlled Trials as Topic
MH  - Stomach Ulcer/chemically induced/*prevention & control
RF  - 103
EDAT- 2003/01/10 04:00
MHDA- 2003/02/22 04:00
CRDT- 2003/01/10 04:00
PHST- 2003/01/10 04:00 [pubmed]
PHST- 2003/02/22 04:00 [medline]
PHST- 2003/01/10 04:00 [entrez]
AID - 10.1002/14651858.CD002296 [doi]
PST - ppublish
SO  - Cochrane Database Syst Rev. 2002;(4):CD002296. doi: 10.1002/14651858.CD002296.