R. Stalnikowicz et D. Rachmilewitz, NSAID-INDUCED GASTRODUODENAL DAMAGE - IS PREVENTION NEEDED - A REVIEWAND METAANALYSIS, Journal of clinical gastroenterology, 17(3), 1993, pp. 238-243
We have reviewed the effects of nonsteroidal antiinflammatory drugs (N
SAIDs) on the gastroduodenal mucosa and then, by means of metaanalysis
, have evaluated the results of therapeutical trials in the prevention
of NSAID-induced gastroduodenal mucosal damage. We searched the liter
ature through Medline (1980-1990) and through the references of releva
nt articles. Of 19 trials retrieved by these means, 11 proved eligible
for metaanalysis on the basis of eight selection criteria defined a p
riori. The data included seven studies where the effect of preventive
treatment during short-term use of NSAIDs was analyzed and four studie
s dealing with prevention of mucosal damage in subjects treated with N
SAIDs for long periods. Results were expressed in terms of the percent
age of patients developing severe mucosal damage or an ulcer during sh
ort- and long-term treatment with NSAIDs, respectively. The pooling of
the results showed that, during short-term NSAID use, 37% of the subj
ects developed severe gastric mucosal damage as compared to 12% of sub
jects given some protective agent. The figures for the duodenum are 13
% and 4%, respectively. Owing to the small number of studies on preven
tion of chronic NSAID-induced gastroduodenal damage, results were not
pooled together; misoprostol was shown to be highly effective in reduc
ing the prevalence of gastric ulcer, and ranitidine prevented the occu
rrence of duodenal but not gastric ulcer. Despite these positive resul
ts, there is no proof that protective agents should be recommended to
the general population requiring NSAIDs therapy. Nor is there yet evid
ence that taking a protective agent will avoid the complications of NS
AIDs, such as bleeding or perforation.