ObjectivesTo systematically review the risk factors for intestinal injury induced by non-steroidal anti-inflammatory drugs(NSAIDs).MethodsWe comprehensively searched WanFang Data, CNKI, Web of Science, EBSCO, PubMed and The Cochrane Library databases to collect studies on risk factors of NSAIDs-induced intestinal injury. Two reviewers independently screened literature, extracted data and assessed risk of bias, and then, meta-analysis was performed by using RevMan 5.2 and STATA 12.0 software.ResultsA total of 6 case-control studies were included, in which 265 patients were in the case group and 301 patients in the control group. The results of meta-analysis showed that PPI was an independent risk factor for NSAIDs-induced intestinal injury (OR=1.59, 95%CI 1.07 to 2.35, P=0.02). In addition, patients with osteoarthritis (OR=2.44, 95% CI 1.11 to 5.36, P=0.03) or rheumatoid arthritis (OR=3.04, 95% CI 1.31 to 7.03, P=0.01) was associated with intestinal mucosal injury induced by NSAIDs. Gender, age, smoking history, drinking history, H2RA and rebamipide medication history, cardiovascular disease and cerebrovascular disease were not associated with intestinal injury.ConclusionsPPI is an independent risk factor for NSAIDs-induced intestinal injury. However, studies with high-quality, larger sample size are required to further verify that PPI increases the prevalence of intestinal injury.
目的 探讨H2受体拮抗剂和质子泵抑制剂（PPI）缓解急性胃黏膜损伤的时效性研究。 方法 对2008年1月－2010年1月在急诊科就诊的98例急性乙醇中毒后胃黏膜损伤患者，随机分为对照组50例，治疗组48例。常规给予休息、保暖，补液，维持水、电解质、酸碱平衡，维持循环功能等治疗基础上，对照组给予H2受体拮抗剂治疗，治疗组给予PPI治疗。通过观察急性胃黏膜损伤患者上消化道症状及体征，记录不同饮酒及饮酒量，并根据患者就诊时间及不同饮酒组治疗后上消化道症状完全缓解时间进行比较。 结果 治疗组上消化道症状缓解所需时间与对照组比较差异有统计学意义（P＜0.001），不同饮酒组上消化道症状缓解时间上差异有统计学意义（P=0.000）。 结论 PPI在缓解急性乙醇中毒所致胃黏膜损伤的时效上更明显，具有临床价值。
【摘要】 目的 〖JP2〗研究质子泵抑制剂（PPI）是否为危重患者发生医院获得性肺炎的危险因素。 方法 收集2002年6月-2009年6月收治的198例重症患者资料，分为使用PPI组（96例）和未使用PPI组（102例）。采用logistic回归分析PPI使用情况和医院获得性肺炎的关系。 结果 使用PPI组肺炎的发生率较高（26.9%），尤其是PPI使用时间超过7 d者（37.5%）。在不同的多变量logistic回归模型中，分别用APACHE Ⅱ评分和入住重症监护室原因校正后，使用PPI以及使用天数均是医院获得性肺炎发生的危险因素（P=0.031，OR＝2.230，95%CI：1.957~2.947；P=0.002，OR＝1.824，95%CI：1.457~2.242）。 结论 长时间应用PPI可能是增加ICU患者发生医院获得性肺炎的一种风险因素。【Abstract】 Objective To identify whether proton pump inhibitors (PPI) is a risk factor of hospital-acquired pneumonia (HAP) in critical patients. Methods The clinical data of the critical patients admitted to ICU from June 2002 to June 2009 were retrospectively analyzed. A total of 198 patients were divided into two groups: 96 in PPI group and 102 in non-PPI group. The relationship between PPI and HAP was analyzed by logistic regression. Results The patients in PPI group had a higher risk of HAP (26.9%), especially who were treated with PPI more than 7 days (37.5%). Adjusted by APACHE Ⅱ score and reason for admission to ICU, PPI therapy and the using duration of PPI were both the risk factors of HAP in different multiple logistic models (P=0.031, OR=2.230, 95%CI: 1.957-2.947; P=0.002, OR=1.824, 95%CI: 1.457-2.242). Conclusion Long-term use of PPI is a risk factor of HAP.
Objective To perform a systematic review on the safety (i.g. cardiovascular, mortality and gastrointestinal bleeding) of clopidogrel versus clopidogrel combined with proton pump inhibitors (PPIs) for the patients with coronary heart disease. Methods Such databases as The Cochrane Library, PubMed, EMbase, SSCI, VIP, CNKI, and CBM were searched from the date of their establishment to September 2010. The bibliographies of the retrieved articles were also checked. The data was extracted and evaluated by two reviewers independently. The RevMan 5.0 software was used for meta-analyses. Results A total of 29 studies were included. The results of meta-analyses showed that the use of clopidogrel combined with PPIs was associated with increasing the risk of cardiovascular events (RR=1.27, 95%CI 1.09 to 1.47), as well as myocardial infarction (RR=1.45, 95% CI 1.20 to 1.76), total mortality (RR=1.23, 95%CI 1.06 to 1.43), and rethrombosis (RR=1.37, 95%CI 1.01 to 1.86). However, there was no enough evidence to reach the conclusion that the combination use could benefit the situation of gastrointestinal bleeding (RR=0.84, 95%CI 0.47 to 1.50). Conclusion?Compared with clopidogrel, the combination use of clopidogrel and PPIs increases cardiovascular events, mortality, and the risks of myocardial infarction and rethrombosis. However, more clinical studies are required to assess the effect of reducing gastrointestinal bleeding.
ObjectiveTo systematically review the association between use of proton pumps inhibitors (PPIs) and clostridium difficile infection (CDI), so as to provide evidence for doctors' prescription. MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 8, 2015), Web of Science, Ovid, CBM, CNKI, VIP, WanFang Data to collect case-control studies and cohort studies about the association between use of PPIs and CDI from January 1990 to October 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 47 articles involving 50 studies with 309620 cases were included. According to whether infected by clostridium difficile or not, these cases were divided into the case group (n=15913) and the control group (n=293707). The result of meta-analysis showed that the CDI rate of the PPIs therapy group was higher than that of the control group (OR=1.99, 95%CI 1.72 to 2.31, P<0.01, I2=87%) but a significant heterogeneity was found among studies. So subgroup analyses were performed according to the type of study design, type of patients, sample size and NOS scores of included studies. The results showed that, within different subgroups, the CDI rate of the PPIs therapy group was higher than that of the control group with significance, but the heterogeneity among studies was still existed. ConclusionCurrent evidence shows the use of PPI is associate with a 2-fold increase of the risk of CDI. Due to limited quality of the included studies, the above conclusion needs to be verified by more high quality studies.
Objective To make an individualized treatment plan for one first-visit gastro-esophageal reflux disease patient via evidence-based medicine methods. Methods The condition of the patient was evaluated comprehensively, then clinical problems were put forward according to PICO principle, and high-quality evidence was collected from The Cochrane Library (1990 to 2010), PubMed (1990 to 2010), and EMbase (1990 to 2010). The treatment plan was designed based on the evaluation of evidence, doctor’s experience, and patient’s preferences. Results A total of 17 RCTs and 10 meta-analyses/ systematic reviews were included. The evidence showed that the therapeutic effect of PPI was better than that of H2RA, and meanwhile prokinetic drugs should be used. When PPI needed to be use for a long time, HP eradication operation was required for the combination of HP inflammation. Laparoscopic fundoplication surgery was a better choice if the operation was required. Based on the above evidence combined with the patient’s preferences, the combination of general treatment, esomeprazole and cisaPride were adopted to treat. Meanwhile, anti-HP medicine was used to control the HP inflammation caused by the long-term maintenance therapy. The gastro-esophageal reflux symptoms were remarkably relieved six months after the treatment. Conclusion PPI plus prokinetic drugs, combined with HP eradication of gastroesophageal reflux surgery, can improve the clinical outcomes and patient’s quality of life. However, long-term prognostic benefits need to be confirmed by further follow-up.
ObjectiveTo research on the advances of stress ulcer drug prophylaxis. MethodsGuidelines for stress ulcer prophylaxis in and out of China were searched and analyzed. Risk factors for stress ulcer, recommended prevention drugs and safety of medicines were summarized. ResultsThe risk factors for stress ulcer included mechanical ventilation, coagulopathy, severe sepsis, multiple organ failure, shock, severe head injury, burns, major trauma, older than 65 and drug use. The recommended prevention drugs included proton pump inhibitors, H2-receptor antagonist and misoprostol, which played a role in the reduction of bleeding in intensive care units. However, recommended drugs had little function in the reduction of bleeding in general patients outside the intensive care units, which was even not recommended or supported in the clinical literature. Related adverse effects of these drugs also needed careful consideration. ConclusionExistence of risk factors for stress ulcer does not necessarily indicate the use of preventive drugs. Drug prophylaxis is used only for critically ill patients. This view summarized by the author provides a reference for physicians and pharmacists.
ObjectiveTo further evaluate the relation between usage of proton pump inhibitor (PPI) and the risk of pancreatic cancer. MethodThe observational studies were systematically searched in the databases of PubMed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov, CNKI, Wanfang, and VIP. The combined odds ratio (OR) and 95% confidence interval (CI) of pancreatic cancer risk were estimated by the corresponding effect model according to the heterogeneous results, and the subgroup analysis, meta-regression, and sensitivity analysis were performed. In addition, the relation between the defined daily dose (DDD) and usage time of PPI and the pancreatic cancer risk were studied by using restricted cubic spline. ResultsA total of 14 studies were included, including 1 601 430 subjects. The meta-analysis result showed that usage of PPI was positively correlated with the risk of pancreatic cancer [I2=98.9%, OR (95%CI)=1.60 (1.21, 2.11), P<0.001]. The subgroup analysis results showed that usage of PPI would increase the risk of pancreatic cancer in the subgroups of literature published before 2018 [OR (95%CI)=1.88 (1.05, 3.38), P=0.034], non-Asian regions [OR (95%CI)=1.37 (1.04, 1.82), P=0.028], case-control studies [OR (95%CI)=1.59 (1.16, 2.18), P=0.004], cohort studies [OR (95%CI)=1.65 (1.13, 2.39), P=0.009], and high-quality studies [OR (95%CI)=1.62 (1.19, 2.20), P=0.002]. The dose-response curve showed that there was a nonlinear relation between the usage of PPI and the risk of pancreatic cancer (χ2linear=2.27, P=0.132; Pnonlinear=0.039). When the usage of PPI was 800 DDD or less, usage of PPI would increase the risk of pancreatic cancer, but there was no statistical significance when the usage of PPI was more than 800 DDD. The time-effect curve showed that there was a linear relation between the usage time of PPI and the risk of pancreatic cancer (χ2linear=6.92, P=0.009), and the risk of pancreatic cancer would increase by 2.3% if the usage of PPI increased by one month [OR=1.02, 95%CI (1.01, 1.04), P=0.009]. The sensitivity analysis confirmed that the results were stable by gradually eliminating each study, the OR (95%CI) of the risk of pancreatic cancer was 1.37 (1.08, 1.74) to 1.66 (1.22, 2.27), and the publication bias was not found by Egger test (P=0.594).ConclusionsFrom the results of this meta-analysis, usage of PPI will increase the risk of pancreatic cancer, and the dosage of PPI and usage time of PPI may be related to the risk of pancreatic cancer. The clinical usage of PPI should be strictly controlled, and the dosage and usage time should also be carefully considered.
Objective To compare the risk of bone fractures in proton pump inhibitor users and nonusers, so as to evaluate the effects of proton pump inhibitors on the risk of bone fractures. Methods We searched PubMed, MEDLINE and EMbase databases to March 1st 2011 to identify case-control studies or cohort studies evaluating the risk of fracture in proton pump inhibitor users and nonusers. We conducted systematic review and meta-analysis according to the fracture site, duration of exposure, average daily dose and time of last use. Summary odds ratios (OR) and 95% confidence interval (CI) were calculated by RevMan 5.0.25 software. We also calculated and looked for heterogeneity. Results Eleven studies were identified from ten literatures, including seven case-control studies and four cohort studies. In case-control studies, the risk of total fractures increased by 36% in proton pump inhibitor users as compared with nonusers (OR=1.36, 95%CI 1.20 to 1.55). The risk of hip fracture increased by 39% (OR=1.39, 95%CI 1.13 to 1.71). In cohort studies, the risk of total fractures increased by 59% (OR=1.59, 95%CI 1.47 to 1.73). The risk of non-hip fractures increased by 65% (OR=1.65, 95%CI 1.47 to 1.85). As compared with nonusers, fracture risk increased by 41% in current users and by 38% in past users whose last use was at least 1 year ago. There was no significant difference between the two groups. Conclusion Proton pump inhibitors increase the risk of fracture to a certain degree. The effect does not fade away by discontinuation of PPI use for at least one year. Stricter clinical trials are needed to exclude confounding factors.
目的 研究质子泵抑制剂在反流性食管炎维持治疗的临床疗效。 方法 将2009年3月-月门诊及住院的121例反流性食管炎并胃镜证实病灶已愈合，且停药1周内症状又复发者，随机分为A、B、C 3组，3组均选用兰索拉唑。A组为兰索拉唑15 mg，1次/d，早餐前服；B组为兰索拉唑15 mg，1次/d，晚餐前服；C组兰索拉唑15 mg，2次/d，餐前服。3组疗程均为4周。疗程结束后进行临床症状疗效评定，并予复查胃镜，评价3组胃镜下总有效率，并观察3组不良反应。 结果 三种方案有效率分别为77.5%、95.0%、92.7%。 结论 晚餐前15 mg 1次/d的兰索拉唑为反流性食管炎较佳维持治疗方案。