PPIs Prevent Aspirin-Induced Gastrointestinal Bleeding Better than H2RAs. A Systematic Review and Meta-analysis

• Published in: Journal of gastrointestinal and liver diseases : JGLD 2017-12, Vol.26 (4), p.395-402
• Main Authors: Szabó, Imre L., Mátics, Robert, Hegyi, Péter, Garami, Andras, Illés, Anita, Sarlós, Patricia, Bajor, Judit, Szűcs, Ákos, Mosztbacher, Dóra, Márta, Katalin, Szemes, Kata, Csekő, Kata, Kővári, Bálint, Rumbus, Zoltán, Vincze, Áron
• Format: Article
• Language: English
• ISSN: 1841-8724; 1842-1121
• DOI: 10.15403/jgld.2014.1121.264.hra

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