Systematic review and Meta-analysis of preventive treatment for low-dose Aspirin-associated gastrointestinal injury in patients with history of peptic ulcer
WAN Ning1 ZHANG Tiantian2 DONG Yanmin3 JI Bo1
1.Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangdong Province, Guangzhou 510010, China;
2.College of Pharmacy, Ji′nan University, Guangdong Province, Guangzhou 510632, China;
3.Department of Pharmacy, the 154th Central Hospital of PLA, He′nan Province, Xinyang 464000, China
Abstract：Objective To demonstrate the efficacy of proton pump inhibitors (PPIs) and control drugs in the prevention of low dose Aspirin (LDA) related gastrointestinal (GI) injuries in patients with peptic ulcer history, thus reducing the abuse of PPIs. Methods By searching PubMed, Cochrane Library and Embase database upto May 2018, the randomized controlled trials on the efficacy of preventive therapy [PPIs, H2 receptor antagonist (H2RA), Vonoprazan, and gastric mucosal protective agents] in reducing the risks of GI events in patients taking long term LDA were collected. Results A total of 9 studies were included with a total of 3067 patients. PPIs were superior to placebo and gastric mucosal protective agents in preventing ulcer recurrence and upper gastrointestinal bleeding (UGIB). Vonoprazan (OR = 2.61, 95%CI: 0.81-8.41) and H2RA (OR = 0.36, 95%CI: 0.04-3.54) showed similar efficacy to PPIs in preventing peptic ulcer recurrence. As for prevention of UGIB, Vonoprazan was superior to PPIs, while H2RA was inferior to that of PPIs. In patients with a history of Hp-induced upper GI hemorrhage, Hp eradication treatment had a similar prophylactic effect as PPIs. Conclusion The results suggest that Vonoprazan and H2RA are as effective as PPIs for the prevention of recurrent peptic ulcer, and Vonoprazan exhibits better efficacy for the prevention of UGIB with PPIs. In patients with a history of Hp infection, the eradication treatment has a similar effect as PPIs. Hence, PPIs may not be the best choice for the prevention of LDA associated GI injures.
万宁1 张田甜2 董艳敏3 杨晨1 季波1. 消化性溃疡史患者中小剂量阿司匹林相关的胃肠损伤预防性治疗的系统评价与Meta分析[J]. 中国医药导报, 2019, 16(3): 109-114,135.
WAN Ning1 ZHANG Tiantian2 DONG Yanmin3 JI Bo1. Systematic review and Meta-analysis of preventive treatment for low-dose Aspirin-associated gastrointestinal injury in patients with history of peptic ulcer. 中国医药导报, 2019, 16(3): 109-114,135.
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2019, Vol. 16 
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