peptic ulcer disease

Gastroprotectant drugs treat and prevent peptic ulcer disease and its associated complications. A recent study from the UK provides insight into the effects of different gastroprotectant drugs in various clinical situations.

Peptic ulcer disease includes ulcers of the stomach and of the upper intestine. Ulcers of the stomach are called peptic ulcers, and ulcers of the upper intestine are called duodenal ulcers. Peptic ulcer disease also includes the complications that may arise from untreated ulcers. These complications may include gastrointestinal bleeding, perforation, and obstruction.

The two most common causes of peptic ulcer disease include Helicobacter pylori infection and the use of non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen. The three major gastroprotectant drugs that prevent and treat peptic ulcer disease and its complications are proton pump inhibitors, prostaglandin analogues, and histamine-2 receptor antagonists. Evidence, however, is lacking regarding which gastroprotectant drug works best in different clinical situations.

Researchers from the Nuffield Department of Population Health in the United Kingdom conducted a meta-analysis to examine the effects of the different classes of gastroprotectants in various clinical situations. Their results were recently published in The Lancet Gastroenterology and Hepatology.

The researchers selected studies in which participants were randomly assigned a gastroprotectant drug and where the authors included a comparison with placebo or another gastroprotectant drug. They included three different types of studies in their analysis: prevention trials, treatment or healing trials, and upper gastrointestinal bleeding treatment trials.

Across all studies, the use of any gastroprotectant drug versus a placebo reduced the risk of developing an endoscopically diagnosed ulcer, a symptomatic ulcer, or ulcer complications.

In prevention trials, where patients did not have any evidence of peptic ulcer disease at the start of the study, proton pump inhibitors were most effective for preventing duodenal ulcers. Prostaglandin analogues were most effective for preventing gastric ulcers. For symptomatic ulcers in healing trials, proton pump inhibitors were also more effective; however, not enough data was present to compare the effectiveness of the treatment of gastric and duodenal ulcers.

In upper gastrointestinal bleeding trials, proton pump inhibitors were also more effective than prostaglandin analogues and histamine-2 receptor antagonists. Evidence for peptic ulcer disease complications other than upper gastrointestinal bleeding is lacking.

Overall, proton pump inhibitors are more effective than other gastroprotectant drugs for the treatment and prevention of peptic ulcer disease and its associated complications. Prostaglandin analogues perform better for preventing gastric ulcers. Further analyses are required to compare the safety profiles of each gastroprotectant drug and each drug’s effect on peptic ulcer disease complications other than bleeding.

Written by Jessica Caporuscio, PharmD

Reference: Scally B, Emberson JR, Spata E, et al. Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials. Lancet Gastroenterol Hepatol. 2018.

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