[Antisecretory drugs and prophylaxis of secondary gastrointestinal effects associated with the consumption of non steroid anti-inflammatory drugs].
BACKGROUND
To evaluate the available evidence on the efficacy of antisecretory drugs in the prevention of serious upper gastrointestinal adverse events associated with the use of nonsteroidal antiinflammatory drugs (NSAID).


METHODS
All studies published and abstracted in the MEDLINE from 1970 to 1999 were reviewed. Only randomized, double-blind and placebo-controlled studies with a follow-up longer than 4 weeks were selected. The variables upper gastrointestinal complications, gastric ulcer, duodenal ulcer and side effects in both primary and secondary prophylaxis were analyzed by meta-analysis techniques.


RESULTS
No studies were available regarding the effects of antisecretory drugs in the prevention of upper gastrointestinal bleeding associated with NSAID use. Ten studies were identified in the prevention of both gastric and duodenal ulcers. The effect of these agents was found to be especially useful in the prevention of duodenal ulcers, in secondary prophylaxis and in the long-term use of NSAID. The most consistent effect was seen with omeprazole for both duodenal ulcer prevention (OR [95% CI] = 0.12 [0.06-0.23]) and gastric ulcer prevention (OR = 0.20 [0.13-0.31)]. However, H2-receptor, antagonists were not significantly associated with gastric ulcer prevention in all the scenarios analyzed.


CONCLUSIONS
Prescription of antisecretory drugs are justified in the prevention of both gastric and duodenal ulcers in patients taking NSAID. The best benefit is achieved with omeprazole.
Servicio de Aparato Digestivo, Hospital Clínico Universitario, Zaragoza. alanas@posta.unizar.es
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Lanas
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Arroyo
D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D009853:Omeprazole / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000517:prevention & control*; D011899:Ranitidine / Q000627:therapeutic use*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004791:Enzyme Inhibitors; D011899:Ranitidine; D009853:Omeprazole