Prevention of NSAID-induced gastroduodenal ulcers.

@article{Rostom2002PreventionON,
  title={Prevention of NSAID-induced gastroduodenal ulcers.},
  author={Alaa Rostom and Catherine Dub{\'e} and George A Wells and Peter Tugwell and Vivian Andrea Welch and Emilie Jolicoeur and Jessie McGowan},
  journal={The Cochrane database of systematic reviews},
  year={2002},
  volume={4},
  pages={
          CD002296
        }
}
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. [] Key MethodSEARCH 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…

The effectiveness of five strategies for the prevention of gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs: systematic review

No evidence of effectiveness of H2 receptor antagonists for any primary outcomes is found, and misoprostol, COX-2 specific and selective NSAIDs, and probably proton pump inhibitors significantly reduce the risk of symptomatic ulcers, but data quality is low.

Prevention of Acute NSAID-Induced Gastroduodenal Damage : Which Strategy is the Best ?

The use of gastroprotective drugs in patients requiring NSAIDS for short periods of time, or alternatively the use of cyclooxygenase-2 inhibitors is recommended in certain clinical conditions.

Management of NSAID-Induced Gastrointestinal Toxicity

Proton pump inhibitors appear to be very effective in treating NSAID-related dyspepsia, and also in healing gastric and duodenal ulcers in patients continuing to receive the NSAID, and an analysis of data from comparative studies of PPIs versus ranitidine, misoprostol and sucralfate shows a therapeutic advantage in favour of the PPI.

Nonsteroid anti-inflammatory drug-induced gastroduodenal injury

Current evidence indicates that a PPI and a cyclooxygenase (COX)-2-selective NSAID provides the best gastric protection, and physicians should select an NSAID according to individual patients' cardiovascular risk.

Prevention of NSAID-related upper gastrointestinal toxicity: a meta-analysis of traditional NSAIDs with gastroprotection and COX-2 inhibitors

Several strategies are available to reduce the risk of upper GI toxicity with tNSAIDs, but a strategy of a COX-2 with a PPI appears to offer the greatest GI safety, but the choice needs to consider patients’ underlying GI and cardiovascular risk.

Prevention and Treatment of NSAID Gastropathy

When dyspepsia develops in an NSAID user, PPI co-therapy plus reduction of the NSAID dose or a change in the type of NSAID are valid alternatives, but clinical experience shows that, for some patients, stopping NSAID therapy may be the only option.

The rise and decline of nonsteroidal antiinflammatory drug-associated gastropathy in rheumatoid arthritis.

The risk of serious NSAID gastropathy has declined by 67% in these cohorts since 1992, and it is estimated that 24% of this decline was the result of lower doses of NSAIDs, while 18% was associated with the use of proton-pump inhibitors and 14% with theUse of less toxic NSAIDs.

Bisphosphonate increases risk of gastroduodenal ulcer in rheumatoid arthritis patients on long-term nonsteroidal antiinflammatory drug therapy

Bisphosphonate co-therapy as well as advanced age and smoking was found to be a significant risk factor in PU, while co-Therapies of standard-dose H2RA or PPI/PG proved effective in preventing PU in Japanese RA patients on long-term NSAID treatment.
...

References

SHOWING 1-10 OF 79 REFERENCES

NSAID-induced gastroduodenal damage: is prevention needed? A review and metaanalysis.

There is no proof that protective agents should be recommended to the general population requiring NSAIDs therapy, nor is there yet evidence that taking a protective agent will avoid the complications of NSAIDs, such as bleeding or perforation.

Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: controlled trial of ranitidine.

Ranitidine 150 mg twice daily significantly reduced the incidence of duodenal ulceration but not gastric ulcers when prescribed concomitantly with one of four commonly used non-steroidal anti-inflammatory drugs.

Misoprostol prevents NSAID-induced gastroduodenal lesions in patients with osteoarthritis and rheumatoid arthritis.

It is concluded that misoprostol is safe and effective in the protection against NSAID-induced gastric and duodenal mucosal lesions and symptoms.

Cimetidine therapy in nonsteroidal anti-inflammatory drug gastropathy. Double-blind long-term evaluation.

The failure of cimetidine to offer any significant benefit under these protocol conditions reflects the fundamental difference in pathophysiologic features between classic acid-mediated ulcer disease and NSAID gastropathy.

Nizatidine prevents peptic ulceration in high-risk patients taking nonsteroidal anti-inflammatory drugs.

It was showed that nizatidine, 150 mg, twice daily, significantly reduces the incidence of ulcer formation in high-risk patients taking long-term NSAID therapy, and also relieves NSAID-associated dyspeptic symptoms in some patients.

Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis.

Users of NSAIDs are at approximately three times greater relative risk for developing serious adverse gastrointestinal events than are nonusers.

Duodenal and Gastric Ulcer Prevention with Misoprostol in Arthritis Patients Taking NSAIDs

The efficacy of misoprostol is investigated for the prevention of NSAID-induced duodenal ulcers in arthritis patients receiving long-term NSAID therapy.

Efficacy of pantoprazole in the prevention of peptic ulcers, induced by non-steroidal anti-inflammatory drugs: a prospective, placebo-controlled, double-blind, parallel-group study.

Nizatidine in therapy and prevention of non-steroidal anti-inflammatory drug-induced gastroduodenal ulcer in rheumatic patients.

There was a tendency to higher healing rates in the case of gastric ulcers after 4 weeks following the higher dose of nizatidine, and erosion, in the stomach and duodenum as well as oesophagitis, improved to a similar degree with all niz atidine doses.

Efficacy and Tolerability of Pantoprazole Compared with Misoprostol for the Prevention of NSAID-Related Gastrointestinal Lesions and Symptoms in Rheumatic Patients

Pantoprazole was superior to misoprostol in the prevention of NSAID-induced gastrointestinal lesions and symptoms in patients on continuous long-term treatment with NSAIDs due to rheumatic diseases and at risk to develop such lesions or symptoms.
...