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Proton-pump inhibitors reduce the risk of uncomplicated peptic ulcer in elderly either acute or chronic users of aspirin/non-steroidal anti-inflammatory drugs
Article first published online: 29 NOV 2004
DOI: 10.1111/j.1365-2036.2004.02246.x
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How to Cite
Pilotto, A., Franceschi, M., Leandro, G., Paris, F., Cascavilla, L., Longo, M. G., Niro, V., Andriulli, A., Scarcelli, C. and Di Mario, F. (2004), Proton-pump inhibitors reduce the risk of uncomplicated peptic ulcer in elderly either acute or chronic users of aspirin/non-steroidal anti-inflammatory drugs. Alimentary Pharmacology & Therapeutics, 20: 1091–1097. doi: 10.1111/j.1365-2036.2004.02246.x
Publication History
- Issue published online: 29 NOV 2004
- Article first published online: 29 NOV 2004
- Accepted for publication 18 August 2004
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Summary
Background : Although administration of gastroprotective drugs may reduce the risk of peptic ulcers associated with the chronic use of non-steroidal anti-inflammatory drugs or aspirin, no consensus exists as to whether this co-therapy is effective for short-term prevention, particularly in old age.
Aim : To evaluate the risk of peptic ulcer associated with acute and chronic non-steroidal anti-inflammatory drugs or aspirin therapy in elderly subjects, and the influence of antisecretory treatment on this risk.
Methods : The study included 676 elderly non-steroidal anti-inflammatory drugs or aspirin users and 2435 non-users who consecutively underwent upper gastrointestinal endoscopy. The use of non-steroidal anti-inflammatory drugs and/or aspirin as well as antisecretory drugs (H2-blockers and proton-pump inhibitors) was evaluated by a structured interview. Diagnosis of gastric and duodenal ulcer as well as Helicobacter pylori infection were carried out by endoscopy and histological examination of the gastric mucosa.
Results : About 47.3% of patients were acute and 52.7% chronic users of non-steroidal anti-inflammatory drugs or aspirin. The risk of peptic ulcer, adjusted for age, gender, H. pylori infection and antisecretory drug use was higher in acute (gastric ulcer: odds ratio, OR =4.47, 95% CI: 3.19–6.26 and duodenal ulcer: OR =2.39, 95% CI: 1.73–3.31) than chronic users (gastric ulcer: OR = 2.80, 95% CI: 1.97–3.99 and duodenal ulcer: OR = 1.68, 95% CI: 1.22–2.33). Proton-pump inhibitor treatment was associated with a reduced risk of peptic ulcer in both acute (OR = 0.70, 95% CI: 0.24–2.04) and chronic (OR = 0.32, 95% CI: 0.15–0.67) non-steroidal anti-inflammatory drugs/aspirin users. Conversely, concomitant treatment with H2-blockers was associated with a significantly higher risk of peptic ulcer both in acute (OR = 10.9, 95% CI: 3.87–30.9) and chronic (OR = 6.26, 95% CI: 2.56–15.3) non-steroidal anti-inflammatory drugs/aspirin users than non-users. Proton-pump inhibitor treatment resulted in an absolute risk reduction of peptic ulcer by 36.6% in acute and 34.6% in chronic non-steroidal anti-inflammatory drugs/aspirin users; indeed, the number needed to treat to avoid one peptic ulcer in elderly non-steroidal anti-inflammatory drugs/aspirin users was three both in acute and chronic users.
Conclusions : These findings suggest that proton-pump inhibitor co-treatment is advisable in symptomatic elderly patients who need to be treated with non-steroidal anti-inflammatory drugs and/or aspirin for a short period of time.