Primary Prevention of Adverse Gastroduodenal Effects from Short-Term Use of Non-Steroidal Anti-Inflammatory Drugs by Omeprazole 20 mg in Healthy Subjects: A Randomized, Double-Blind, Placebo-Controlled Study

Abstract

The effectiveness of low-dose omeprazole as primary prevention of gastrointestinal adverse events due to episodic use of non-selective NSAIDs was evaluated. Healthy adults aged 50-75 who did not take chronic NSAIDs were randomized to a 6.5-day treatment of naproxen 500 mg twice daily plus omeprazole 20 mg daily or naproxen 500 mg twice daily plus placebo. Seventy subjects were enrolled (mean age 58.6 years, proportion >60 = 41.4%). Subjects receiving naproxen plus omeprazole developed fewer gastroduodenal ulcers compared to subjects receiving naproxen plus placebo (11.8% vs. 46.9%, P = 0.002). Likewise, naproxen plus omeprazole was associated with a decreased risk of ulceration and/or >5 erosions (38.2% vs. 81.3%, P < or = 0.001), and a smaller change in dyspepsia score. Considering their relatively low cost, ready availability, and favorable safety profile, low-dose PPI co-prescription in healthy adults requiring short-term therapy with non-selective NSAIDs may be reasonable.

NSAID‐induced antral ulcers are associated with distinct changes in mucosal gene expression

“…The current gene expression study was performed in a sub-group of patients who participated in a clinical study of the effectiveness of omeprazole in preventing naproxen-induced injury (19). …”

“…The current gene expression study was performed in a sub-group of patients who participated in a clinical study of the effectiveness of omeprazole in preventing naproxen-induced injury. 19 In the clinical study, 70 subjects were divided into two treatment arms (naproxen plus placebo, naproxen plus omeprazole), and four subjects were treated with placebo alone. Major inclusion criteria included: age 50-75 years; generally good health; willingness to sign the informed consent.…”

Lower Urinary Tract Cancer

“…Drugs such as omeprazole or famotidine could be considered to reduce the risk of gastrointestinal side effects from NSAIDs; although there is no published evidence in companion animals, there is evidence in humans that this approach can reduce the risk of NSAID-induced gastric or duodenal ulceration. [26][27][28] Routine biochemical monitoring for renal and liver function and evidence of gastrointestinal ulceration is recommended for all dogs on NSAIDs, especially those considered at risk of urinary tract obstruction. Cytotoxic agents with reported activity include mitoxantrone, carboplatin, cisplatin, doxorubicin, vinblastine, gemcitabine, vinorelbine, metronomic chlorambucil, and intravesical mitomycin C. 18,[29][30][31][32][33][34][35][36][37][38][39] Mitoxantrone, carboplatin, and vinblastine in combination with NSAIDs are common first-line agents with reported response rates ranging from 35% to 38%.…”

Comment utiliser les antalgiques non opiacés en postopératoire ?

“…Bien que des lésions muqueuses soient visibles en fibroscopie dès une semaine de traitement, les complications décrites en postopé-ratoire sont essentiellement mineures (dyspepsie, nausées) et observées avec les AINS-T et les ISCOX-2. L'adjonction d'un inhibiteur de la pompe à protons à un traitement par AINS-T permet de limiter ces lésions y compris lors d'un traitement court de 5 jours [28]. Au total, le bénéfice des ISCOX-2 en termes de protection gastrique est surtout intéressant pour les traitements au long cours, la toxicité gastrique des AINS-T posant peu de problèmes lors d'une prescription de courte durée en postopératoire.…”