Role of proton pump inhibitors in non-steroidal anti-inflammatory drugs-associated gastrointestinal disease: A meta-analysis

Background: Proton pump inhibitors (PPI) are widely used in the treatment of non-steroidal anti-inflammatory drugs (NSAIDs)-associated gastrointestinal diseases, but corresponding evidence-based information is scarce. Aims: To evaluate the clinical efficacy of PPI in NSAIDs-associated gastrointestinal diseases. Methods: Medline and China Biological Medicine Disk were searched for mono- or multicenter randomized controlled clinical trials in patients with the above diseases published from 1979 to October 2005. According to the inclusion criteria, six studies were selected. Two authors cited the details about the design of trials, identities of the participants and the outcomes from the studies independently. The data were analyzed by RevMan4.2 software using random effects model. Results: Six randomized clinical trials including 2280 patients were included. The results of meta-analysis were as follows: PPI vs. placebo: RR 1.33, 95% CI 1.00-1.76, P=0.05; PPI vs. colloidal bismuth: RR 0.99, 95% CI 0.85-1.17, P=0.95; PPI vs. H2 receptor antagonist (H2RA): RR 1.26, 95% CI 1.08-1.46, P=0.002. But homogeneity was not significant for PPI vs. placebo and PPI vs. colloidal bismuth. Conclusions: PPI is effective in relieving NSAIDs-associated gastrointestinal diseases while NASIDs is used continuously. PPI is superior to H2RA, but not to colloidal bismuth.