title: Proton pump inhibitors in prevention of low-dose aspirin-associated upper gastrointestinal injuries.
abstract: OBJECTIVE
  To determine the preventive effect and safety of proton pump inhibitors (PPIs) in low-dose aspirin (LDA)-associated gastrointestinal (GI) ulcers and bleeding.
  
  
  METHODS
  We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register from inception to December 2013, and checked conference abstracts of randomized controlled trials (RCTs) on the effect of PPIs in reducing adverse GI events (hemorrhage, ulcer, perforation, or obstruction) in patients taking LDA. The preventive effects of PPIs were compared with the control group [taking placebo, a cytoprotective agent, or an H2 receptor antagonist (H2RA)] in LDA-associated upper GI injuries. The meta-analysis was performed using RevMan 5.1 software.
  
  
  RESULTS
  We evaluated 8780 participants in 10 RCTs. The meta-analysis showed that PPIs decreased the risk of LDA-associated upper GI ulcers (OR = 0.16; 95%CI: 0.12-0.23) and bleeding (OR = 0.27; 95%CI: 0.16-0.43) compared with control. For patients treated with dual anti-platelet therapy of LDA and clopidogrel, PPIs were able to prevent the LDA-associated GI bleeding (OR = 0.36; 95%CI: 0.15-0.87) without increasing the risk of major adverse cardiovascular events (MACE) (OR = 1.00; 95%CI: 0.76-1.31). PPIs were superior to H2RA in prevention of LDA-associated GI ulcers (OR = 0.12; 95%CI: 0.02-0.65) and bleeding (OR = 0.32; 95%CI: 0.13-0.79).
  
  
  CONCLUSIONS
  PPIs are effective in preventing LDA-associated upper GI ulcers and bleeding. Concomitant use of PPI, LDA and clopidogrel did not increase the risk of MACE.
authors.affiliation: Chen Mo, Gang Sun, Ming-Liang Lu, Li Zhang, Yan-Zhi Wang, Xi Sun, Yun-Sheng Yang, Institute of Digestive Diseases, the Chinese PLA General Hospital, the Chinese PLA Medical Academy, Beijing 100853, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Mo
authors.affiliation: Chen Mo, Gang Sun, Ming-Liang Lu, Li Zhang, Yan-Zhi Wang, Xi Sun, Yun-Sheng Yang, Institute of Digestive Diseases, the Chinese PLA General Hospital, the Chinese PLA Medical Academy, Beijing 100853, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Sun
authors.affiliation: Chen Mo, Gang Sun, Ming-Liang Lu, Li Zhang, Yan-Zhi Wang, Xi Sun, Yun-Sheng Yang, Institute of Digestive Diseases, the Chinese PLA General Hospital, the Chinese PLA Medical Academy, Beijing 100853, China.
authors.forename: Ming-Liang
authors.initials: ML
authors.lastname: Lu
authors.affiliation: Chen Mo, Gang Sun, Ming-Liang Lu, Li Zhang, Yan-Zhi Wang, Xi Sun, Yun-Sheng Yang, Institute of Digestive Diseases, the Chinese PLA General Hospital, the Chinese PLA Medical Academy, Beijing 100853, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Chen Mo, Gang Sun, Ming-Liang Lu, Li Zhang, Yan-Zhi Wang, Xi Sun, Yun-Sheng Yang, Institute of Digestive Diseases, the Chinese PLA General Hospital, the Chinese PLA Medical Academy, Beijing 100853, China.
authors.forename: Yan-Zhi
authors.initials: YZ
authors.lastname: Wang
authors.affiliation: Chen Mo, Gang Sun, Ming-Liang Lu, Li Zhang, Yan-Zhi Wang, Xi Sun, Yun-Sheng Yang, Institute of Digestive Diseases, the Chinese PLA General Hospital, the Chinese PLA Medical Academy, Beijing 100853, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Sun
authors.affiliation: Chen Mo, Gang Sun, Ming-Liang Lu, Li Zhang, Yan-Zhi Wang, Xi Sun, Yun-Sheng Yang, Institute of Digestive Diseases, the Chinese PLA General Hospital, the Chinese PLA Medical Academy, Beijing 100853, China.
authors.forename: Yun-Sheng
authors.initials: YS
authors.lastname: Yang
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D016009:Chi-Square Distribution; D019610:Cytoprotection; D006801:Humans; D016017:Odds Ratio; D010437:Peptic Ulcer / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors; D001241:Aspirin
keywords: Gastrointestinal bleeding; Low dose aspirin; Meta-analyses; Peptic ulcer; Proton pump inhibitor; Randomized controlled trial