Randomised clinical trial: prevention of recurrence of peptic ulcers by rabeprazole in patients taking low‐dose aspirin

Iwakiri, Ryuichi; Higuchi, Kazuhide; Kato, Mototsugu; Fujishiro, Mitsuhiro; Kinoshita, Yoshikazu; Watanabe, Toshio; Takeuchi, Toshihisa; Yamauchi, Masao; Sanomura, Makoto; Nakagawa, Hikoto; Sugisaki, Nobuyuki; Okada, Yasushi; Ogawa, Hisao; Fujimoto, Kazuma

doi:10.1111/apt.12907

Cited by 34 publications

(46 citation statements)

References 47 publications

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“…In rabeprazole groups, there were no bleeding ulcers. Therefore, rabeprazole prevented the recurrence of peptic ulcers without any evidence of a major doseresponse effect in patients on LDA therapy [96].…”

Section: Ppismentioning

confidence: 96%

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Lanas

Gargallo²

2015

J Gastroenterol

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Low-dose aspirin, alone or combined with other antiplatelet agents, is increasingly prescribed for cardiovascular prevention. However, the cardiovascular benefits should be evaluated together with the gastrointestinal risks. Low-dose aspirin is associated with upper and lower gastrointestinal injury, although lower gastrointestinal effects are poorly characterized. This gastrointestinal risk differs among antiplatelets drugs users. The most important risk factors are history of peptic ulcer, older age, and concomitant use of non-steroidal anti-inflammatory drugs or dual antiplatelet therapy. Effective upper gastrointestinal prevention strategies are available and should be used in at-risk patients taking low-dose aspirin or clopidogrel. Proton pump inhibitors seem to be the best gastroprotective agents, whereas the benefits of Helicobacter pylori eradication are still unclear. Low-dose aspirin has additional effects in the gastrointestinal tract. A large body of evidence indicates that it can protect against different cancers, in particular colorectal cancer. This effect could modify the future indications for use of low-dose aspirin and the risk-benefit balance.

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Section: Ppismentioning

confidence: 96%

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Lanas

Gargallo²

2015

J Gastroenterol

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“…Five RCTs, exploring antisecretory drug efficacy for the prevention of LDA‐induced PUD, included extractable data on the impact of H. pylori . Placebo or active controls were employed in all studies.…”

Section: Resultsmentioning

confidence: 99%

“…The pooled effect (fixed‐effect) and heterogeneity were again similar to the complete analysis; however, the effect size was larger (OR 1.94, 95%CI 1.54–2.46; Q = 16.63, P = 0.16; I 2 = 27.83). Complementing this, data were available from four studies ( n = 1007) where all patients were receiving PPIs . In those, the pooled effect size was no longer significantly different from unity (OR 1.20, 95%CI 0.48–2.96), although the statistical power was fairly low.…”

Section: Resultsmentioning

confidence: 99%

Helicobacter pylori and low‐dose aspirin ulcer risk: A meta‐analysis

Sarri

Grigg

Yeomans

2018

J of Gastro and Hepatol

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Background and Aim Owing to wide‐spread use, low‐dose aspirin (LDA) produces a substantial amount of peptic ulcer disease. Current guidelines are ambivalent about the need for Helicobacter pylori eradication to protect against LDA ulcers. This study aimed to determine, through meta‐analysis, if (and by how much) infection alters the baseline risk of peptic ulcers during LDA therapy. Methods Literature screening was performed in MEDLINE and EMBASE from inception to May 2018. Original studies reporting prevalence or incidence of uncomplicated ulcers in LDA users were included. Ulcer endpoints needed to be specified separately, according to H. pylori infection status. Meta‐analysis was performed in MIX 2.0 Pro. Results Ten cross‐sectional studies and seven randomized controlled trials were included (n = 5964). The pooled odds ratios with 95% confidence intervals (CI) for the risk of LDA ulcers in H. pylori‐positive versus H. pylori‐negative individuals were 1.68 (95%CI 1.40–2.02) and 1.65 (95%CI 1.29–2.08) under fixed‐effects and random‐effects models, respectively. Heterogeneity among studies was minimal (I2 = 26.9%). After adjusting for the protective effects of antisecretory drugs, the odds ratios increased to 1.94 (95%CI 1.54–2.46). Conclusion This analysis suggests that H. pylori increases the risk of LDA ulcers by almost 70% in a population where some were taking proton pump inhibitors and/or other acid suppressants. Without antisecretory drugs, the risk almost doubles. Clinically, these findings may support the use of a test‐and‐treat approach to H. pylori in LDA users, particularly those already at higher risk of developing peptic ulcers.

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“…(8.6%) [29] . Although LDA therapy is being used with increasing frequency to treat and prevent arterial thrombotic disease, administration with a PPI is required to prevent the development of drug-induced ulcers and GERD in subjects currently taking LDA for cardiovascular protection.…”

mentioning

confidence: 99%

Gastroesophageal Reflux Disease in Time Covering Eradication for All Patients Infected with <b><i>Helicobacter pylori</i></b> in Japan

Sugimoto

Uotani²,

Ichikawa³

et al. 2016

Digestion

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Background: The prevalence of gastroesophageal reflux disease (GERD) has increased in Japan since the end of the 20th century due to changes in environmental factors, such as a decreased infection rate of Helicobacter pylori and increased ability of acid secretion in the Japanese population. In 2013, the Japanese health insurance system started to cover eradication treatment for all patients infected with H. pylori to prevent gastric cancer, suggesting we may soon be able to completely eradicate this infection in Japan. Re-clarification of the clinical characteristics of GERD in Japan is therefore required in time covering the eradication for all patients infected with H. pylori. Summary: In Japan, more than half of GERD patients exhibit non-erosive reflux disease, and a majority of erosive esophagitis (RE) cases have mild severity of GERD (Los Angeles classification of grades A and B). The prevalence of RE in H. pylori-positive patients is relatively low (4.1%) compared to the general Japanese population (7.6-10.6%). In multivariate analysis to evaluate a risk of RE development, a risk in H. pylori-positive patients is elevated in those with mild gastric mucosal atrophy (C-I and C-II according to the Kimura-Takemoto classification, OR 12.14, 95% CI 1.28-115.26, p = 0.03) or with hiatal hernia (OR 5.24, 95% CI 1.80-15.22, p < 0.01). Here, we provide a comprehensive review of GERD in Japan, including associations between GERD and H. pylori infection, low-dose-aspirin-induced GERD, and pharmacological treatment for GERD. Key Messages: The recent decrease in the rate of H. pylori infection and increase in the proportion of elderly persons might have increased the prevalence of GERD in Japan.

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Randomised clinical trial: prevention of recurrence of peptic ulcers by rabeprazole in patients taking low‐dose aspirin

Abstract: SUMMARY BackgroundFew studies have evaluated the effects of rabeprazole on low-dose aspirin (LDA)-induced gastroduodenal injuries.

Cited by 34 publications

References 47 publications

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Helicobacter pylori and low‐dose aspirin ulcer risk: A meta‐analysis

Gastroesophageal Reflux Disease in Time Covering Eradication for All Patients Infected with <b><i>Helicobacter pylori</i></b> in Japan

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