Prevention of NSAID-induced gastroduodenal ulcers

Rostom, Alaa; Dubé, Catherine; Wells, George A.; Tugwell, Peter; Welch, Vivian; Jolicoeur, Emilie; McGowan, Jessie; Lanas, Ángel; Rushton, Eleanor; Shukla, Tushar

doi:10.1002/14651858.cd002296

Cited by 335 publications

(336 citation statements)

References 89 publications

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“…An important detail that has been neglected by these authors is the reinfection rate. This study revealed a reinfection of 8,69% over an average follow-up period of three years, similar to the one found by Schutze, et al 23 .…”

Section: Discussionsupporting

confidence: 92%

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients

Dalcin¹,

Abaid²,

Almeida³

et al. 2009

ABCD, arq. bras. cir. dig.

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BACKGROUND: The surgical treatment for perforated peptic ulcer is still a matter of discussion. The surgeons, for many years, made their options between acid-reducing procedures with some morbi-mortality and simpler procedures like closure of the perforation. But, in these cases, were faced with a high chance of ulcer relapse. Since the proved link between peptic ulcer and gastroduodenal infection caused by H. pylori, a recommendation for a change in their attitudes going back to simpler procedures with eradication of the bacteria was done. AIM: To analyse ulcer recurrence in patients treated with the same surgical procedure but belonging to two different groups: positive and negative to H. pilori. METHODS: A total of 144 patients were treated with simple closure of their perforated pre-pyloric, pyloric and duodenal ulcers. Thirty days after operation they were submitted to upper endoscopy and tested for the bacteria by urease and histopathological exams and divided into two groups according to the results of the tests: positive and negative. The positive ones were eradicated and, together with the negative group, were followed through six months interval endoscopies and detection tests looking for ulcer relapses and reinfection in the eradicated group. The positive group consisted of 25 patients, with two patients considered non eradicable according to the treatment protocol. They were followed for an average period of 38,21 months. RESULTS: Relapse was detected in four patients (17,39%), half of them (8,69%) were reinfected. The negative group consisted of 26 patients, with a median follow-up of 38,28 months and eight (30,76%) relapses were detected. There was no statistical significant difference due probably to the high dropout of patients. CONCLUSION: Simple suture with H. pilori eradication is the gold standard for the positive group, leaving the question of acid-reducing procedures open for the negative ones.

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Section: Discussionsupporting

confidence: 92%

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients

Dalcin¹,

Abaid²,

Almeida³

et al. 2009

ABCD, arq. bras. cir. dig.

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“…The advisory committee members voted 16 to 9 against a change in labeling for specific NSAIDs, suggesting that further evidence on the safety of NSAIDs may be warranted 7 . Famotidine, through inhibition of histamine 2 (H2) receptors, prevents NSAID-induced UGI ulceration by reducing gastric acid secretion [13][14][15][16] and has a longer duration of action than other H2-receptor antagonists (H2RAs) 15,17 . Moreover, famotidine may be a practical alternative to proton pump inhibitors (PPIs) in some patients because it is more ideally paired with shorter half-life NSAIDs, such as ibuprofen, from a pharmacokinetic and patient adherence perspective 18 .…”

Section: Introductionmentioning

confidence: 99%

“…Evidence from the literature demonstrates that double doses of H2RAs produce significant relative risk (RR) reductions in gastric and duodenal ulcers (RR ¼ 0.44, 95% confidence interval [CI] 0.26-0.74 and RR ¼ 0.26, 95% CI 0.11-0.65, respectively), and are as efficacious as PPIs for the prophylaxis of GI damage from NSAIDs, and are better tolerated than misoprostol 13,22 .…”

Section: Introductionmentioning

confidence: 99%

One-year safety of ibuprofen/famotidine fixed combination versus ibuprofen alone: pooled analyses of two 24-week randomized, double-blind trials and a follow-on extension

Bello

Grahn

Ball

et al. 2015

Current Medical Research and Opinion

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Objective:To evaluate the safety of the fixed combination of ibuprofen and famotidine compared with ibuprofen alone from two 24-week, multicenter, double-blind trials designed to evaluate the comparative incidence of endoscopically documented upper gastrointestinal ulcers and a 28-week double-blind extension study. Research design and methods:Safety was analyzed by pooling data from the two double-blind trials and the follow-on study. Safety was assessed by monitoring the incidence, causality, and severity of adverse events (AEs). Results:In the pivotal efficacy and safety trials, discontinuation rates due to any cause and dyspepsia were significantly lower for the ibuprofen/famotidine combination versus ibuprofen alone. Other than dyspepsia, gastrointestinal and cardiovascular AEs of special interest were similar. Events judged to be treatment related were significantly lower with the ibuprofen/famotidine combination (20.6% vs. 25%). In the safety extension population, there were no differences in the discontinuation rates and the reporting of AEs or serious AEs (SAEs) between the two groups. Gastrointestinal-related events were similar between the groups. Incidence of cardiovascular-related AEs of special interest were 11% (ibuprofen/famotidine) and 2% (ibuprofen) (p ¼ 0.06), possibly due to a higher number of rheumatoid arthritis patients in the combination group. Of these, 80% were reports of hypertension (8% ibuprofen/famotidine vs. 2% ibuprofen). Three cases of hypertension in the ibuprofen/famotidine group were considered treatment related. The probability of a cardiovascular event decreased during days 112-167 of treatment and remained low with continued treatment. Conclusions:One-year safety data from two pivotal trials and a long-term extension study indicate that the ibuprofen/ famotidine combination demonstrates a favorable gastrointestinal safety profile and more patients continued on therapy compared to ibuprofen alone. No new safety signals have been identified. These data offer additional evidence supporting a new therapeutic option to improve gastrointestinal safety and adherence for patients who require long-term ibuprofen.

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“…The most prominent members of this group are aspirin (5), ibuprofen (6), naproxen (7), diclofenac (8), and indomethacin (9). Most NSAIDs inhibit the activity of cyclooxygenase-1 and cyclooxygenase-2 and thereby the synthesis of prostaglandins and thromboxanes.…”

Section: Introductionmentioning

confidence: 99%

“…Most NSAIDs inhibit the activity of cyclooxygenase-1 and cyclooxygenase-2 and thereby the synthesis of prostaglandins and thromboxanes. Inhibiting COX-2 leads to the desirable antiinflammatory, analgesic and antipyretic activities whereas the inhibition of COX-1 leads to undesirable side effect like gastrointestinal bleeding 8 , kidney problems 9 , and central nervous system (CNS) effects 10 . The work of Caughey et al 11 and Varas-Lorenzo et al 12 has associated NSAIDs use with increased risk of stroke.…”

Section: Introductionmentioning

confidence: 99%

Novel anti-inflammatory and analgesic agents: synthesis, molecular docking and in vivo studies

Ugwu

Okoro

Ukoha

et al. 2018

Journal of Enzyme Inhibition and Medicinal Chemistry

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Twelve new derivatives of benzothiazole bearing benzenesulphonamide and carboxamide were synthesised and investigated for their in vivo anti-inflammatory, analgesic and ulcerogenic activities. Molecular docking showed an excellent binding interaction of the synthesised compounds with the receptors, with 17c showing the highest binding energy (-12.50 kcal/mol). Compounds 17c and 17i inhibited carrageenan-induced rat paw oedema at 72, 76, and 80% and 64, 73, and 78% at 1 h, 2 h, and 3 h, respectively. In the analgesic activity experiment, compounds 17c, 17 g, and 17i had ED 50 (mM/kg) of 96, 127, and 84 after 0.5 h; 102, 134, and 72 after 1 h and 89, 156, and 69 mM/kg after 2 h, respectively, which were comparable with 156, 72, and 70 mM/kg for celecoxib. The ulcerogenic index of the most active derivatives 17c and 17i were 0.82 and 0.89, respectively, comparable to 0.92 for celecoxib. The physicochemical studies of the new derivatives showed that they will not have oral bioavailability problems. ARTICLE HISTORY

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Prevention of NSAID-induced gastroduodenal ulcers

Abstract: Analysis 1.7. Comparison 1: Misoprostol vs placebo -primary e icacy, Outcome 7: Total endoscopic ulcers Chan 2001 removed Prevention of NSAID-induced gastroduodenal ulcers (Review)

Cited by 335 publications

References 89 publications

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients

One-year safety of ibuprofen/famotidine fixed combination versus ibuprofen alone: pooled analyses of two 24-week randomized, double-blind trials and a follow-on extension

Novel anti-inflammatory and analgesic agents: synthesis, molecular docking and in vivo studies

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