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PPI versus Histamine H2 Receptor Antagonists for Prevention of Upper Gastrointestinal Injury Associated with Low-Dose Aspirin: Systematic Review and Meta-analysis.

Mo C, Sun G, Wang YZ, Lu ML, Yang YS - PLoS ONE (2015)

Bottom Line: We included nine RCTs involving 1047 patients.In conclusion, PPIs were superior to H2RAs for prevention of LDA-related GI erosion/ulcer and bleeding.Higher quality, large, multicenter RCTs are needed to demonstrate the preventive effect of the two acid-suppressive drugs.

View Article: PubMed Central - PubMed

Affiliation: Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, China; Cadre Ward No. 2, the General Hospital of Chinese Armed Force Police, Beijing 100039, China.

ABSTRACT
This study compared proton pump inhibitors (PPIs) and histamine H2 receptor antagonists (H2RAs) for prevention of low-dose aspirin (LDA)-related gastrointestinal (GI) erosion, ulcer and bleeding. Electronic databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, and WanFang Data were searched from the date of their establishment to December 31, 2013. Randomized controlled trials comparing PPIs and H2RAs for prevention of GI injury associated with low-dose aspirin (LDA) were collected. Two reviewers independently abstracted studies and patient characteristics and appraised study quality using the Cochrane risk-of-bias tool. Meta-analysis was performed using RevMan 5.1 software. We included nine RCTs involving 1047 patients. The meta-analysis showed that PPIs were superior to H2RAs for prevention of LDA-associated GI erosion/ulcer [odds ratio (OR=0.28, 95% confidence interval (CI): 0.16-0.50] and bleeding (OR=0.28, 95% CI: 0.14-0.59). In conclusion, PPIs were superior to H2RAs for prevention of LDA-related GI erosion/ulcer and bleeding. Higher quality, large, multicenter RCTs are needed to demonstrate the preventive effect of the two acid-suppressive drugs.

No MeSH data available.


Related in: MedlinePlus

Flow chart of retrieved articles.
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pone.0131558.g001: Flow chart of retrieved articles.

Mentions: The literature search identified 735 articles: 497 published in English and 238 in Chinese. Five hundred and seventy-two articles were excluded because they were duplicate publications or did not meet the inclusion criteria. One hundred and twenty articles were excluded after reading the titles and abstracts. Forty-three full-text articles were retrieved, including 34 articles published in English and nine in Chinese. Twelve articles were excluded because they were not RCTs[15–26]; eight because they compared the therapeutic effects[18,27–33]; seven because they did not investigate upper GI endpoints[34–40]; and seven because they were pharmacokinetic experiments[41–47]. The details of References to Studies Excluded in meta-analysis please see in Supporting Information (S1 File). Nine RCTs fulfilled the inclusion criteria including three in English [48–50] and six in Chinese [51–56]. Fig 1 shows the flow chart of the retrieved articles. The level of agreement between the two reviewers was acceptable (κ = 0.67).


PPI versus Histamine H2 Receptor Antagonists for Prevention of Upper Gastrointestinal Injury Associated with Low-Dose Aspirin: Systematic Review and Meta-analysis.

Mo C, Sun G, Wang YZ, Lu ML, Yang YS - PLoS ONE (2015)

Flow chart of retrieved articles.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493004&req=5

pone.0131558.g001: Flow chart of retrieved articles.
Mentions: The literature search identified 735 articles: 497 published in English and 238 in Chinese. Five hundred and seventy-two articles were excluded because they were duplicate publications or did not meet the inclusion criteria. One hundred and twenty articles were excluded after reading the titles and abstracts. Forty-three full-text articles were retrieved, including 34 articles published in English and nine in Chinese. Twelve articles were excluded because they were not RCTs[15–26]; eight because they compared the therapeutic effects[18,27–33]; seven because they did not investigate upper GI endpoints[34–40]; and seven because they were pharmacokinetic experiments[41–47]. The details of References to Studies Excluded in meta-analysis please see in Supporting Information (S1 File). Nine RCTs fulfilled the inclusion criteria including three in English [48–50] and six in Chinese [51–56]. Fig 1 shows the flow chart of the retrieved articles. The level of agreement between the two reviewers was acceptable (κ = 0.67).

Bottom Line: We included nine RCTs involving 1047 patients.In conclusion, PPIs were superior to H2RAs for prevention of LDA-related GI erosion/ulcer and bleeding.Higher quality, large, multicenter RCTs are needed to demonstrate the preventive effect of the two acid-suppressive drugs.

View Article: PubMed Central - PubMed

Affiliation: Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, China; Cadre Ward No. 2, the General Hospital of Chinese Armed Force Police, Beijing 100039, China.

ABSTRACT
This study compared proton pump inhibitors (PPIs) and histamine H2 receptor antagonists (H2RAs) for prevention of low-dose aspirin (LDA)-related gastrointestinal (GI) erosion, ulcer and bleeding. Electronic databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, and WanFang Data were searched from the date of their establishment to December 31, 2013. Randomized controlled trials comparing PPIs and H2RAs for prevention of GI injury associated with low-dose aspirin (LDA) were collected. Two reviewers independently abstracted studies and patient characteristics and appraised study quality using the Cochrane risk-of-bias tool. Meta-analysis was performed using RevMan 5.1 software. We included nine RCTs involving 1047 patients. The meta-analysis showed that PPIs were superior to H2RAs for prevention of LDA-associated GI erosion/ulcer [odds ratio (OR=0.28, 95% confidence interval (CI): 0.16-0.50] and bleeding (OR=0.28, 95% CI: 0.14-0.59). In conclusion, PPIs were superior to H2RAs for prevention of LDA-related GI erosion/ulcer and bleeding. Higher quality, large, multicenter RCTs are needed to demonstrate the preventive effect of the two acid-suppressive drugs.

No MeSH data available.


Related in: MedlinePlus