SYSTEMATIC REVIEW AND META-ANALYSIS
PPIs Prevent Aspirin-Induced Gastrointestinal Bleeding Better than H2RAs. A Systematic Review and Meta-analysis
Imre L. Szabó1, Robert Mátics2, Péter Hegyi1,2,3, Andras Garami2, Anita Illés1, Patricia Sarlós1, Judit Bajor1, Ákos Szűcs4, Dóra Mosztbacher5, Katalin Márta2, Kata Szemes1, Kata Csekő1, Bálint Kővári1, Zoltán Rumbus2, Áron Vincze1
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1) First Department of Medicine, Division of Gastroenterology;
2) Institute for Translational Medicine, University of Pécs, Pécs;
3) Hungarian Academy of Sciences – University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged;
4) First Department of Surgery, Semmelweis University, Budapest;
5) Department of Pediatrics, County Hospital, Szekszárd, Hungary
Background & Aims: Aspirin is one of the most widely used medication for its analgesic and anti-platelet properties and thus a major cause for gastrointestinal (GI) bleeding. This study compared the preventive effect of histamine-2 receptor antagonists (H2RAs) and proton-pump inhibitors (PPIs) against chronic low-dose aspirin (LDA)-related GI bleeding and ulcer formation.
Methods: Electronic databases of Pubmed, Embase and Cochrane Central Register of Controlled Trials were searched for human observations (randomised controlled trials and observational studies) comparing the long term effects of PPIs and H2RAs treatment in the prevention of GI bleeding or ulcer formation in patients on chronic LDA treatment listed up till September 30, 2016. Two independent authors searched databases using PICO questions (aspirin, H2RA, PPI, GI bleeding or ulcer), and reviewed abstracts and articles for comprehensive studies keeping adequate study quality. Data of weighted odds ratios were statistically evaluated using Comprehensive Metaanalysis (Biostat, Inc., Engelwood, MJ, USA), potential bias was checked.
Results: Nine studies for GI bleeding and eight studies for ulcer formation were found meeting inclusion criteria, altogether 1,879 patients were included into review. The H2RAs prevented less effectively LDA-related GI bleeding (OR= 2.102, 95% CI: 1.008-4.385, p<0.048) and ulcer formation (OR= 2.257, 95% CI: 1.277-3.989, p<0.005) than PPIs.
Conclusion: The meta-analysis showed that H2RAs were less effective in the prevention of LDA-related GI bleeding and ulcer formation suggesting the preferable usage of PPIs in case of tolerance.
Key words: Low-dose aspirin treatment – Proton pump inhibitors – Histamine receptor antagonists – Gastrointestinal bleeding – Ulcer – Aspirin-induced gastroenteropathy.
Abbreviations: COX -1: cyclooxygenase-I enzyme; COX-2: cyclooxygenase-II enzyme; GI: gastrointestinal; H2RA(s): histamine-2 receptor antagonist(s); H. pylori: Helicobacter pylori; LDA: low dose aspirin; NSAID(s): non-steroid anti-inflammatory drug(s); OR: Odds ratio; PPI(s): proton-pump inhibitor(s); RCT: randomized controlled trial; RR: relative risk; UGIB: upper gastrointestinal bleeding.