Who Needs Gastroprotection in 2020?
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Who Needs Gastroprotection in 2020? Takeshi Kanno1,2 Paul Moayyedi, BSc MB ChB PhD MPH FRCP FRCPC AGAF, FACG, CAGF2,3,* Address 1 Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan 2 Farncombe Family Digestive Health Institute, McMaster University, Hamilton, Ontario, Canada *,3 Audrey Campbell Chair of Ulcerative Colitis Research, Division of Gastroenterology, Department of Medicine, McMaster University, 1280 Main St. W. HSC 3V3, Hamilton, ON, L8S 4K1, Canada Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
Keywords Proton pump inhibitor I Helicobacter pylori I Peptic ulcer disease I Non-steroidal anti-inflammatory drugs I Risk-benefit
Abstract Purpose of review Peptic ulcer disease (PUD) is a recognized complication of non-steroidal anti-inflammatory drugs (NSAIDs). Stress ulcers are a concern for intensive care unit (ICU) patients; PUD is also an issue for patients taking anticoagulation. Helicobacter pylori test and treat is an option for patients starting NSAID therapy, and proton pump inhibitors (PPIs) may reduce PUD in NSAID patients and other high-risk groups. Recent findings There are a large number of trials that demonstrate that Helicobacter pylori eradication reduces PUD in NSAID patients. PPI is also effective at reducing PUD in this group and is also effective in ICU patients and those on anticoagulants. The effect is too modest for PPI to be recommended in everyone, and more research is needed as to which groups would benefit the most. Increasing age, past history of PUD, and comorbidity are the most important risk factors. Summary H. pylori test and treat should be offered to older patients starting NSAIDS, while PPIs should be prescribed to patients that are at high risk of developing PUD and at risk of dying from PUD complications.
Introduction Upper gastrointestinal (GI) bleeding is a major health problem, and mortality from this problem has remained relatively unchanged for the last 50 years [1–3]. The apparent stability of a 5–12% in-patient
30-day mortality rate hides significant changes in the epidemiology and management of the condition. Major advances have been made in the management of upper gastrointestinal bleeding including the routine
Hot Topics use of proton pump inhibitor therapy after a peptic ulcer bleed which improves outcomes and probably reduces mortality [4]. Endoscopic therapy also improves the outcomes of peptic ulcer and variceal bleeding [5]. The age-adjusted rates of peptic ulcer (PU) bleeding have fallen globally over the last 20 years largely due to the falling prevalence of Helicobacter pylori (H. pylori) [6, 7], but a modest contribution may relate to the increasing use of acid suppression in the community [8]. These positive factors have been balanced by the fluctuating use of non-steroidal anti-inflammatory drug (NSAID) [9] and by the increased use of antiplatelet [10] and anticoagulant therapy [11] over time. Furthermore, the absolute nu
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