Key result
PPIs are linked to a ~66% lower gastroduodenal ulcer risk in patients taking low-dose aspirin.
Why the study?
The prevalence of gastroduodenal injuries and the risk factor profile including gastroprotective drug therapy in Japanese patients taking daily aspirin for cardioprotection needed clarification.
Do proton pump inhibitors reduce the risk of gastroduodenal injuries in high-risk cardiovascular patients taking daily aspirin?
Observational (n=1,454)
Yes
Do proton pump inhibitors reduce the risk of gastroduodenal injuries in high-risk cardiovascular patients taking daily aspirin?
In Japanese patients taking low-dose aspirin for cardioprotection, gastroduodenal injuries are common, but concurrent use of proton pump inhibitors significantly reduces this risk.
Answers are grounded in this paper and cite their sources.
May support PPI gastroprotection in Japanese aspirin users; extends observational data but leaves open RCT confirmation.
BACKGROUND: Low-dose aspirin is widely used for the prevention of cardiovascular events. The prevalence of gastroduodenal injuries and the risk factor profile including gastroprotective drug therapy needs to be clarified in Japanese patients taking daily aspirin for cardioprotection. METHODS: This Management of Aspirin-induced Gastro-Intestinal Complications (MAGIC) study was conducted with a prospective nationwide, multicenter, real-world registry of Japanese patients at high-risk of cardiovascular diseases who were taking regular aspirin (75-325 mg) for 1 month or more. All patients underwent endoscopic examination for detection of gastroduodenal ulcer and mucosal erosion. The risk factor profiles including the concurrent drug therapy were compared for those patients with gastroduodenal problems and those without. RESULTS: Gastroduodenal ulcer and erosion were detected in 6.5, and 29.2% of the 1,454 patients receiving aspirin, respectively. H. pylori infection was associated with an increased risk for ulcer: OR 1.83 (1.18-2.88 p = 0.0082). Risk of erosion was lower with enteric-coated aspirin than with buffered aspirin: odds ratio (OR) 0.47 (0.32-0.70, p = 0.0002). Patients receiving proton pump inhibitors had lower risks for both gastroduodenal ulcer and erosion: OR 0.34 (0.15-0.68, p = 0.0050) and 0.32 (0.22-0.46, p < 0.0001), respectively. However, those receiving histamine 2-receptor antagonists had reduced risks for erosion but not for ulcer: OR 0.49 (0.36-0.68, p < 0.0001). CONCLUSION: Gastroduodenal ulcer and erosion are common in Japanese patients taking low dose aspirin for cardioprotection. Proton pump inhibitors reduce the risk of gastroduodenal mucosal injury.
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Uemura et al. (2013) conducted an observational in Cardiovascular disease requiring low-dose aspirin (n=1,454). Proton pump inhibitors vs. No proton pump inhibitor was evaluated on Gastroduodenal ulcer (OR 0.34, 95% CI 0.15-0.68, p=0.0050). In Japanese patients taking low-dose aspirin for cardioprotection, the concurrent use of proton pump inhibitors was associated with a reduced risk of gastroduodenal ulcer.
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