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

Chen, Mo; Sun, Gang; Yanzhi, Wang; Lu, Ming-Liang; Yang, Yunsheng

doi:10.1371/journal.pone.0131558

Cited by 42 publications

(33 citation statements)

References 45 publications

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“…They are more effective at lowering the risk of upper GI peptic ulcer bleeding than H2RAs (32). In the present study, PPIs significantly lowered the risk of peptic ulcer bleeding.…”

Section: Discussionsupporting

confidence: 53%

Immunosuppressive agents are associated with peptic ulcer bleeding

Tomizawa

Shinozaki

Hasegawa

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Peptic ulcer bleeding can be fatal. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and immunosuppressive agents are administered for long-term usage. The present study assessed the association between peptic ulcer bleeding and administration of NSAIDs, corticosteroids and immunosuppressive agents. Furthermore, the efficacy of lowering the risk of peptic ulcer bleeding with proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) was evaluated. Medical records were retrospectively analyzed for patients subjected to an upper gastrointestinal (GI) endoscopy performed at the National Hospital Organization Shimoshizu Hospital (Yotsukaido, Japan) from October 2014 to September 2015. During this period, a total of 1,023 patients underwent an upper GI endoscopy. A total of 1,023 patients, including 431 males (age, 68.1±12.9 years) and 592 females (age, 66.4±12.3 years), who had been administered NSAIDs, corticosteroids, immunosuppressive agents, PPIs and H2RAs, were respectively enrolled. Endoscopic findings of the patients were reviewed and their data were statistically analyzed. Logistic regression analysis was used to determine the odds ratio of peptic ulcer bleeding for each medication; immunosuppressive agents had an odds ratio of 5.83, which was larger than that for NSAIDs (4.77). The Wald test was applied to confirm the correlation between immunosuppressive agents and peptic ulcer bleeding. Furthermore, χ 2 tests were applied to the correlation between peptic ulcer bleeding and administration of PPIs or H2RAs. Immunosuppressive agents had the largest χ 2 , and the P-value was 0.03. Administration of PPIs was significantly correlated with non-peptic ulcer bleeding (P= 0.02); furthermore, a tendency toward non-peptic ulcer bleeding with administration of H2RA was indicated, but it was not statistically significant (P= 0.12). In conclusion, immunosuppressive agents were correlated with peptic ulcer bleeding and PPIs were effective at lowering the risk of peptic ulcer bleeding.

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“…They are more effective at lowering the risk of upper GI peptic ulcer bleeding than H2RAs (32). In the present study, PPIs significantly lowered the risk of peptic ulcer bleeding.…”

Section: Discussionsupporting

confidence: 53%

Immunosuppressive agents are associated with peptic ulcer bleeding

Tomizawa

Shinozaki

Hasegawa

et al. 2017

Experimental and Therapeutic Medicine

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“…Unfortunately, these strategies have not been studied head‐to‐head and there is no clearly superior strategy based upon available data. Furthermore, certain de‐escalation strategies may not be appropriate for all patients, as H2 blockers are inferior in reflux treatment and relapse regardless of GERD phenotype and do not prevent aspirin, NSAID, antiplatelet, or anticoagulant associated ulceration and bleeding . Our study found that physicians were not only changing their PPI prescribing habits, but also screening their patients on PPIs for bone disease more frequently.…”

Section: Discussionmentioning

confidence: 82%

Reported proton pump inhibitor side effects: what are physician and patient perspectives and behaviour patterns?

Ghosh

Schnoll‐Sussman

Mathews

et al. 2019

Aliment Pharmacol Ther

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Summary Background Proton pump inhibitors (PPI) are among the most commonly prescribed medications and studies are reporting potentially harmful PPI‐related adverse events. While these studies’ findings are controversial, their impact on patients and physicians remains unknown. Aim To determine patient and physician awareness of PPI‐related adverse events, source of information, and subsequent effect on patient behaviour and physician practice. Methods A 20‐item questionnaire was administered to English speaking adult patients and physicians in primary care and specialty clinics about topics including knowledge of PPI‐related adverse events, change in behaviour of patients on PPIs and physician management of patients on PPIs. Results Of 277 patients surveyed, 45% reported knowledge of side effects related to PPIs. Patients were more likely to hear about PPI side effects from non‐physician sources (66%) than physicians (38%). Of patients who had heard about PPI side effects, bone fractures and osteoporosis were the most common concerns, 42% and 44% respectively. Of PPI users, 38% changed their behaviour based upon concerns about PPI‐related adverse events. Change in patient behaviour due to concern about PPI side effects was associated with age ≥ 65 years (odds ratio [OR] 4.07 [1.19‐13.94]; P = 0.03) and concern about long‐term side effects (OR 2.31 [1.03‐5.17]; P = 0.04). Of 83 physicians surveyed, 60% reported concern about PPI‐related adverse events, with bone fractures (46%) and osteoporosis (49%) being the most frequently reported. Overall, 37% of physicians reported changing their practice based upon their concerns. Conclusions Nearly half of patients reported knowledge of PPI‐related adverse events, most often from non‐physician sources, and general concern regarding their impact. PPI users are changing their behaviour based upon these concerns, without physician input, and care providers are changing behaviour based on relatively weak evidence.

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“…Six articles fulfilled all criteria [28][29][30][31][32][33]. One systematic review [34] checked during the assessment cited six additional Chinese papers fulfilling inclusion criteria and showed data suitable for comparison. The committee of reviewers accepted the inclusion of data derived from these Chinese written articles [35][36][37][38][39][40].…”

Section: Resultsmentioning

confidence: 99%

“…All these raised the question whether the less expensive H2RAs are suitable to prevent aspirin-induced GI bleeding. The only meta-analysis published so far [34] comparing H2RAs to PPI in the prevention of ASA-related GI harms examined exclusively RCT studies up till 2013. In the present study we extended the review to a wider field including data of appropriate observational studies and more recent findings of literature.…”

Section: Discussionmentioning

confidence: 99%

PPIs Prevent Aspirin-Induced Gastrointestinal Bleeding Better than H2RAs. A Systematic Review and Meta-analysis

Szabó¹,

Mátics

Hegyi

et al. 2017

JGLD

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Background & Aims: Aspirin is one of the most widely used medication for its analgesic and anti-platelet properties and thus a major cause for gastrointestinal (GI) bleeding. This study compared the preventive effect of histamine-2 receptor antagonists (H2RAs) and proton-pump inhibitors (PPIs) against chronic low-dose aspirin (LDA)-related GI bleeding and ulcer formation.Methods: Electronic databases of Pubmed, Embase and Cochrane Central Register of Controlled Trials were searched for human observations (randomised controlled trials and observational studies) comparing the long term effects of PPIs and H2RAs treatment in the prevention of GI bleeding or ulcer formation in patients on chronic LDA treatment listed up till September 30, 2016. Two independent authors searched databases using PICO questions (aspirin, H2RA, PPI, GI bleeding or ulcer), and reviewed abstracts and articles for comprehensive studies keeping adequate study quality. Data of weighted odds ratios were statistically evaluated using Comprehensive Metaanalysis (Biostat, Inc., Engelwood, MJ, USA), potential bias was checked.Results: Nine studies for GI bleeding and eight studies for ulcer formation were found meeting inclusion criteria, altogether 1,879 patients were included into review. The H2RAs prevented less effectively LDA-related GI bleeding (OR= 2.102, 95% CI: 1.008-4.385, p<0.048) and ulcer formation (OR= 2.257, 95% CI: 1.277-3.989, p<0.005) than PPIs.Conclusion: The meta-analysis showed that H2RAs were less effective in the prevention of LDA-related GI bleeding and ulcer formation suggesting the preferable usage of PPIs in case of tolerance.Abbreviations: COX -1: cyclooxygenase-I enzyme; COX-2: cyclooxygenase-II enzyme; GI: gastrointestinal; H2RA(s): histamine-2 receptor antagonist(s); H. pylori: Helicobacter pylori; LDA: low dose aspirin; NSAID(s): non-steroid anti-inflammatory drug(s); OR: Odds ratio; PPI(s): proton-pump inhibitor(s); RCT: randomized controlled trial; RR: relative risk; UGIB: upper gastrointestinal bleeding.

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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

Cited by 42 publications

References 45 publications

Immunosuppressive agents are associated with peptic ulcer bleeding

Immunosuppressive agents are associated with peptic ulcer bleeding

Reported proton pump inhibitor side effects: what are physician and patient perspectives and behaviour patterns?

PPIs Prevent Aspirin-Induced Gastrointestinal Bleeding Better than H2RAs. A Systematic Review and Meta-analysis

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