title: Proton pump inhibitors for preventing non-steroidal anti-inflammatory drug induced gastrointestinal toxicity: a systematic review.
abstract: Proton pump inhibitors (PPIs) are recommended for preventing gastrointestinal lesions induced by non-steroidal anti-inflammatory drugs (NSAIDs). We performed this study: (1) to evaluate the effectiveness and safety of PPIs, (2) to explore the association between effectiveness and potential influential factors, and (3) to investigate the comparative effect of different PPIs.
  
  
  
  MEDLINE, EMBASE, and the Cochrane Library were searched to identify randomized controlled trials comparing different classes of PPIs, or comparing PPIs with placebo, H2receptor antagonists or misoprostol in NSAIDs users. Both pairwise meta-analysis and Bayesian network meta-analysis were performed.
  
  
  
  Analyses were based on 12,532 participants from 31 trials. PPIs were significantly more effective than placebo in reducing ulcer complications (relative risk [RR] = 0.29; 95% confidence interval [CI], 0.20 to 0.42) and endoscopic peptic ulcers (RR = 0.27; 95% CI, 0.22 to 0.33), with no subgroup differences according to class of NSAIDs, ulcer risk, history of previous ulcer disease, Helicobacter pylori infection, or age. To prevent one ulcer complication, 10 high risk patients and 268 moderate risk patients need PPI therapy. Network meta-analysis indicated that the effectiveness of different PPIs in reducing ulcer complications and endoscopic peptic ulcers is generally similar. PPIs significantly reduced gastrointestinal adverse events and the related withdrawals compared to placebo; there is no difference in safety between different PPIs.
  
  
  
  PPIs are effective and safe in preventing peptic ulcers and complications in a wide spectrum of patients requiring NSAID therapy. There is no major difference in the comparative effectiveness and safety between different PPIs.
authors.affiliation: a Department of Gastroenterology , Songgang People's Hospital , Shenzhen , Guangdong , China.
authors.forename: Man
authors.initials: M
authors.lastname: Yang
authors.affiliation: b Department of Gastroenterology , Peking University Shenzhen Hospital , Shenzhen , Guangdong , China.
authors.forename: Min
authors.initials: M
authors.lastname: He
authors.affiliation: a Department of Gastroenterology , Songgang People's Hospital , Shenzhen , Guangdong , China.
authors.forename: Miao
authors.initials: M
authors.lastname: Zhao
authors.affiliation: b Department of Gastroenterology , Peking University Shenzhen Hospital , Shenzhen , Guangdong , China.
authors.forename: Bing
authors.initials: B
authors.lastname: Zou
authors.affiliation: a Department of Gastroenterology , Songgang People's Hospital , Shenzhen , Guangdong , China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: a Department of Gastroenterology , Songgang People's Hospital , Shenzhen , Guangdong , China.
authors.forename: Ling-Min
authors.initials: LM
authors.lastname: Luo
authors.affiliation: a Department of Gastroenterology , Songgang People's Hospital , Shenzhen , Guangdong , China.
authors.forename: Qiu-Lan
authors.initials: QL
authors.lastname: Li
authors.affiliation: a Department of Gastroenterology , Songgang People's Hospital , Shenzhen , Guangdong , China.
authors.forename: Jun-Hui
authors.initials: JH
authors.lastname: He
authors.affiliation: a Department of Gastroenterology , Songgang People's Hospital , Shenzhen , Guangdong , China.
authors.forename: Ping-Guang
authors.initials: PG
authors.lastname: Lei
mesh_terms: D006801:Humans; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D016595:Misoprostol / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D016595:Misoprostol; D054328:Proton Pump Inhibitors
keywords: Gastrointestinal toxicity; meta-analysis; non-steroidal anti-inflammatory drugs; proton pump inhibitors