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…Expand
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TLDR
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. Expand
Prevention of Acute NSAID-Induced Gastroduodenal Damage : Which Strategy is the Best ?
Objectives: The aim of this review is to provide data on the efficacy of co-therapy of non selective NSAIDs given for short periods of time with gastroprotective drugs in preventing severeExpand
The Mexican consensus on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy
TLDR
Thirty-three recommendations were formulated in the present consensus, highlighting the fact that the risk for NSAID-induced gastrointestinal toxicity varies according to the drug employed and its pharmacokinetics, which should be taken into account at the time of prescription. Expand
Chapter 18 Gastrointestinal Complications of Anti-Rheumatic Drugs
TLDR
This chapter reviews the current status for treating pain and inflammation in chronic arthritic conditions with Non-steroidal Anti-inflammatory Drugs (NSAIDs) and other drug combinations and numerous strategies to counter the adverse effects of the analgesics, NSAIDs, and steroids are attempted. Expand
Management of NSAID-Induced Gastrointestinal Toxicity
TLDR
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. Expand
Nonsteroid anti-inflammatory drug-induced gastroduodenal injury
TLDR
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. Expand
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TLDR
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. Expand
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TLDR
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. Expand
The rise and decline of nonsteroidal antiinflammatory drug-associated gastropathy in rheumatoid arthritis.
TLDR
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. Expand
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TLDR
The effects of proton-pump inhibitors, prostaglandin analogues, and histamine-2 receptor antagonists in different clinical circumstances by doing meta-analyses of tabular data from all relevant unconfounded randomised trials of gastroprotectant drugs were examined. Expand
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References

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The prevention of chronic NSAID induced upper gastrointestinal toxicity: a Cochrane collaboration metaanalysis of randomized controlled trials.
TLDR
Misoprostol, PPI, and double dose H2RA are effective in preventing chronic NSAID related endoscopic gastric and duodenal ulcers. Expand
NSAID-induced gastroduodenal damage: is prevention needed? A review and metaanalysis.
TLDR
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. Expand
Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: controlled trial of ranitidine.
TLDR
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. Expand
Misoprostol prevents NSAID-induced gastroduodenal lesions in patients with osteoarthritis and rheumatoid arthritis.
TLDR
It is concluded that misoprostol is safe and effective in the protection against NSAID-induced gastric and duodenal mucosal lesions and symptoms. Expand
Cimetidine therapy in nonsteroidal anti-inflammatory drug gastropathy. Double-blind long-term evaluation.
TLDR
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. Expand
Misoprostol Dosage in the Prevention of Nonsteroidal Anti-inflammatory Drug-Induced Gastric and Duodenal Ulcers: A Comparison of Three Regimens
TLDR
The effectiveness and tolerability of three different misoprostol regimens were determined, which were shown to provide significant protection against NSAID-induced gastric and duodenal ulcers and to reduce the incidence of ulcer complications. Expand
Nizatidine prevents peptic ulceration in high-risk patients taking nonsteroidal anti-inflammatory drugs.
TLDR
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. Expand
Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis.
TLDR
Users of NSAIDs are at approximately three times greater relative risk for developing serious adverse gastrointestinal events than are nonusers. Expand
Duodenal and Gastric Ulcer Prevention with Misoprostol in Arthritis Patients Taking NSAIDs
TLDR
The efficacy of misoprostol is investigated for the prevention of NSAID-induced duodenal ulcers in arthritis patients receiving long-term NSAID therapy. Expand
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.
TLDR
Pantoprazole 40 mg once daily was well tolerated and is more effective than placebo in the prevention of peptic ulcers in patients with rheumatic diseases who require continuous, long-term, treatment with NSAIDs. Expand
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