Publication: Comparison of gastrointestinal adverse effects between cyclooxygenase-2 inhibitors and non-selective, non-steroidal anti-inflammatory drugs plus proton pump inhibitors: A systematic review and meta-analysis
Issued Date
2013-07-01
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ISSN
14355922
09441174
09441174
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2-s2.0-84880840708
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of Gastroenterology. Vol.48, No.7 (2013), 830-838
Suggested Citation
Saharat Jarupongprapa, Prapassorn Ussavasodhi, Wanruchada Katchamart Comparison of gastrointestinal adverse effects between cyclooxygenase-2 inhibitors and non-selective, non-steroidal anti-inflammatory drugs plus proton pump inhibitors: A systematic review and meta-analysis. Journal of Gastroenterology. Vol.48, No.7 (2013), 830-838. doi:10.1007/s00535-012-0717-6 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/32276
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Title
Comparison of gastrointestinal adverse effects between cyclooxygenase-2 inhibitors and non-selective, non-steroidal anti-inflammatory drugs plus proton pump inhibitors: A systematic review and meta-analysis
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Abstract
Background: There are conflicting and inconsistent data regarding the gastrointestinal (GI) protective effect of cyclooxygenase-2 (COX-2) inhibitors and of non-steroidal anti-inflammatory drugs (NSAIDs) plus proton-pump inhibitors (PPI). Aim: To compare the adverse GI effects between COX-2 inhibitors and NSAIDs plus PPI. Methods: We performed a systematic review of randomized trials comparing GI adverse effects between COX-2 inhibitors and NSAID plus PPI. Trials were identified in MEDLINE, EMBASE, and the Cochrane Library. Primary outcomes were major GI complications including hemorrhage, perforation, and obstruction. Results: A total of nine trials involving 7,616 participants from 2002 to 2011 were included. All trials were randomized, double blinded, and placebo-controlled with moderate to high quality. COX-2 inhibitors were found to have significantly reduced the risk of major GI events, including perforation, obstruction, and bleeding (relative risk or RR 0.38, 95 % confidence interval or CI 0.25-0.56, p < 0.001); however, the benefit was significant only for patients who were at high risk for NSAID-related GI complications and long-term users. Additionally, the risk of diarrhea (RR 0.56, 95 % CI 0.35-0.9, p 0.02) and withdrawal (RR 0.77, 95 % CI 0.62-0.94, p 0.01) was significantly lower in use of COX-2 inhibitors, while the rate of dyspepsia was higher (RR 1.58, 95 % CI 1.26-1.98, p < 0.001). Conclusions: COX-2 inhibitors significantly reduced the risk of perforation, obstruction, bleeding, diarrhea, and withdrawal due to GI adverse events, while the risk of dyspepsia was lower with NSAIDs plus PPI. © 2012 Springer Japan.