PPIs Lower Risk of Peptic Ulcer Disease

Gastroprotectant drugs, especially proton pump inhibitors (PPIs), are associated with a decreased risk of peptic ulcer disease, according to a recent meta-analysis.

For their analysis, the researchers assessed 124,485 participants enrolled in 849 randomized trials of a gastroprotectant drug (PPIs, prostaglandin analogues, or histamine receptor 2 antagonists [H2RAs]) vs control or another gastroprotectant. The effects of gastroprotectant drugs on ulcer development, bleeding, and overall mortality were assessed in meta-analyses.
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In trials geared toward ulcer prevention, gastroprotectant use was associated with reduced development of endoscopic ulcers (odds ratio [OR] 0.27), symptomatic ulcers (OR 0.25) and upper gastrointestinal bleeding (OR 0.40), but was not significantly associated with reduced mortality (OR 0.85).

The researchers noted that PPIs were most strongly associated with reduced upper gastrointestinal bleeding vs other gastroprotectants.

Furthermore, in trials of patients with acute bleeding, gastroprotectant drugs were found to reduce further bleeding (OR 0.68), blood transfusion (OR 0.75), further endoscopic intervention (OR 0.56), and surgery (0.72), but were not significantly associated with reduced mortality (OR 0.90).

In particular, PPIs had greater protective effects for further bleeding and blood transfusion compared with H2RAs.

“Gastroprotectants, in particular PPIs, reduce the risk of peptic ulcer disease and its complications and promote healing of peptic ulcers in a wide range of clinical circumstances,” the researchers concluded. “However, this meta-analysis might have overestimated the benefits owing to small study bias.”

—Christina Vogt

Reference:

Scally B, Emberson JR, Spata E, et al. Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomized trials [Published online February 20, 2018]. The Lancet Gastroenterol Hepatol. https://doi.org/10.1016/S2468-1253(18)30037-2.