title: [Concomitant use of proton pump inhibitors and systemic corticosteroids].
abstract: OBJECTIVE
  To provide an overview of the incidence of peptic ulcer in patients who use systemic corticosteroids and of the underlying mechanism of action, in order to determine whether there is a need for gastric protection using proton pump inhibitors in these patients.
  
  
  METHODS
  Systematic literature review of published meta-analyses and case-control studies, supported by relevant literature on the effects of corticosteroids in relation to the development of ulcers.
  
  
  METHODS
  Analysis of literature was performed using the PubMed database with the search terms 'adrenal cortex hormones', 'peptic ulcer' and their synonyms. Meta-analyses and case-control studies with more than 1000 patients were included.
  
  
  RESULTS
  The literature search resulted in 970 articles, of which 3 were classified as relevant meta-analyses and 3 as relevant case-control studies. All meta-analyses indicated that peptic ulcer is, at the most, a rare complication of systemic corticosteroid therapy occurring in less than 0.4-1.8% of patients. As the incidence is low, there is no indication for routine prophylaxis with proton pump inhibitors in combination with systemic corticosteroids. There is convincing evidence showing an increased risk of ulcers and a poorer recovery from these when NSAIDs and systemic corticosteroids are used concomitantly; this is a combination for which a proton pump inhibitor should be prescribed.
  
  
  CONCLUSIONS
  Systemic corticosteroid therapy only rarely causes a peptic ulcer. Routine prophylaxis with proton pump inhibitors is therefore not indicated for short-term systemic corticosteroid use.
authors: Nederlands Kanker Instituut-Antoni van Leeuwenhoek Ziekenhuis en Slotervaartziekenhuis, Afd. Apotheek, Amsterdam, the Netherlands.
authors: Thomas P C
authors: TP
authors: Dorlo
authors: Nynke G L
authors: NG
authors: Jager
authors: Jos H
authors: JH
authors: Beijnen
authors: Jan H M
authors: JH
authors: Schellens
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D016022:Case-Control Studies; D004347:Drug Interactions; D006801:Humans; D015994:Incidence; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors