NSAID-INDUCED GASTRODUODENAL DAMAGE - IS PREVENTION NEEDED - A REVIEWAND METAANALYSIS

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.