title: PPI versus Histamine H2 Receptor Antagonists for Prevention of Upper Gastrointestinal Injury Associated with Low-Dose Aspirin: Systematic Review and Meta-analysis.
abstract: This study compared proton pump inhibitors (PPIs) and histamine H2 receptor antagonists (H2RAs) for prevention of low-dose aspirin (LDA)-related gastrointestinal (GI) erosion, ulcer and bleeding. Electronic databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, and WanFang Data were searched from the date of their establishment to December 31, 2013. Randomized controlled trials comparing PPIs and H2RAs for prevention of GI injury associated with low-dose aspirin (LDA) were collected. Two reviewers independently abstracted studies and patient characteristics and appraised study quality using the Cochrane risk-of-bias tool. Meta-analysis was performed using RevMan 5.1 software. We included nine RCTs involving 1047 patients. The meta-analysis showed that PPIs were superior to H2RAs for prevention of LDA-associated GI erosion/ulcer [odds ratio (OR=0.28, 95% confidence interval (CI): 0.16-0.50] and bleeding (OR=0.28, 95% CI: 0.14-0.59). In conclusion, PPIs were superior to H2RAs for prevention of LDA-related GI erosion/ulcer and bleeding. Higher quality, large, multicenter RCTs are needed to demonstrate the preventive effect of the two acid-suppressive drugs.
authors.affiliation: Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, China; Cadre Ward No. 2, the General Hospital of Chinese Armed Force Police, Beijing 100039, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Mo
authors.affiliation: Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Sun
authors.affiliation: Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Yan-Zhi
authors.initials: YZ
authors.lastname: Wang
authors.affiliation: Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Ming-Liang
authors.initials: ML
authors.lastname: Lu
authors.affiliation: Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Yun-Sheng
authors.initials: YS
authors.lastname: Yang
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects*; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D041742:Upper Gastrointestinal Tract / Q000187:drug effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D001241:Aspirin