Proton pump inhibitors for the prevention of non-steroidal anti-inflammatory drug-induced ulcers and dyspepsia
Abstract
Rationale: Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed medicines, commonly used to mitigate pain, inflammation, and cardiovascular prevention, among others. Chronic NSAID consumption increases the risk of acute renal failure, stroke, myocardial infarction, and gastrointestinal toxicity, ranging from mild dyspepsia to serious ulcer complications such as bleeding, obstruction, and perforation. Proton pump inhibitors (PPIs) may exert a gastroprotective effect from NSAID gastroduodenal injury by reducing gastric acid secretion.
Objectives: To assess the effects of proton pump inhibitors on the prevention of dyspepsia and ulcers in people with chronic consumption of non-steroidal anti-inflammatory drugs.
Search methods: We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), and two trial registers up to 23 October 2023, as well as reference checking, citation searching, and contact with study authors to identify additional studies.
Eligibility criteria: We included randomised controlled trials (RCTs) and cluster-RCTs comparing PPIs taken orally versus placebo, histamine 2-receptor antagonists, misoprostol, or sucralfate in adults and children with chronic consumption of NSAIDs for four weeks or longer.
Outcomes: Our outcomes were global symptoms of dyspepsia, incident ulcer, adverse events, ulcer complications, and quality of life.
Risk of bias: We used the Cochrane RoB 2 tool for RCTs and the tool extension for cluster-RCTs.
Synthesis…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 8,760 participants or records.
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