Prevention Of Long-term Low-dose Aspirin Associated Peptic Ulcer With Proton Pump Inhibitor:a Meta-analysis

Aims:Systematically review the preventive effect of the proton pump inhibitor for aspirin-related peptic ulcer on the long-term taking low-dose aspirin (75-325mg) patients.Methods:All randomized controlled trials (RCTs) before December16,2013on proton pump inhibitor preventing low-dose aspirin associated peptic ulcer were selected in VIP, WANFANG, CNKI, CBM, Pubmed, Embase and Cochrane library. Two researchers screened all literatures independently according to inclusion and exclusion criteria. RevMan5.2was used for meta-analysis.Results:6RCTs were enrolled, there were4275patients in total. The results of meta-analysis showed that the proton pump inhibitor could significantly reduce the risk of aspirin associated peptic ulcer on the long-term taking low-dose aspirin patients (RR=0.2,95%CI0.15to0.26, P＜0.00001) compared with the control group. The subgroup meta-analysis according to the different parts of ulcers showed that the risk of stomach ulcers (RR=0.26,95%CI0.14to0.47, P＜0.0000l) was higher than duodenal ulcer (RR=0.19,95%CI0.08to0.48, P=0.0004).There were4studies involved the correlation between proton pump inhibitor and Hp Infection. The results showed that the proton pump inhibitor could reduce the risk of Hp infection on the long-term taking aspirin patients, but the difference had no statistical significance (RR=0.8,95%CI0.62to1.02, P=0.08) compared with the control group. Part of the studies showed that esomeprazole could be effective in preventing the epigastric burning sensation of the long-term taking aspirin patients, and relieving the epigastric pain, acid reflux, heartburn symptoms as well, and the difference was statistically significant (P<0.05).The adverse reactions of proton pump inhibitor had been reported rarely in these studies.Conclusion:The proton pump inhibitor could effectively reduce the risk of aspirin-related peptic ulcer on the patients that long-term taking low-dose aspirin for primary and secondary prevention of cardiovascular disease, and can be well tolerated. The proton pump inhibitor might also reduce the Hp infection.