Department of Medicine and Geriatric, Ruttonjee Hospital, Hong Kong, China.
Gastroenterology. 2010 Jan;138(1):82-8. doi: 10.1053/j.gastro.2009.09.063. Epub 2009 Nov 11.
BACKGROUND & AIMS: Little is known about the efficacy of H(2)-receptor antagonists in preventing recurrence of aspirin-related peptic ulcers. We compared the efficacy of high-dose famotidine with that of pantoprazole in preventing recurrent symptomatic ulcers/erosions.
We performed a randomized, double-blind, controlled trial of 160 patients with aspirin-related peptic ulcers/erosions, with or without a history of bleeding. Patients were given either famotidine (40 mg, morning and evening) or pantoprazole (20 mg in the morning and placebo in the evening). All patients continued to receive aspirin (80 mg daily). The primary end point was recurrent dyspeptic or bleeding ulcers/erosions within 48 weeks.
A total of 130 patients (81.1%) completed the study; 13 of 65 patients in the famotidine group reached the primary end point (20.0%; 95% one-sided confidence interval [CI] for the risk difference, 0.1184-1.0) compared with 0 of 65 patients in the pantoprazole group (P < .0001, 95% one-sided CI for the risk difference, 0.1184-1.0). Gastrointestinal bleeding was significantly more common in the famotidine group than the pantoprazole group (7.7% [5/65] vs 0% [0/65]; 95% one-sided CI for the risk difference, 0.0226-1.0; P = .0289), as was recurrent dyspepsia caused by ulcers/erosions (12.3% [8/65] vs 0% [0/65]; 95% one-sided CI for the risk difference, 0.0560-1.0; P = .0031). No patients had ulcer perforation or obstruction.
In patients with aspirin-related peptic ulcers/erosions, high-dose famotidine therapy is inferior to pantoprazole in preventing recurrent dyspeptic or bleeding ulcers/erosions.
关于 H2 受体拮抗剂在预防阿司匹林相关消化性溃疡复发中的疗效知之甚少。我们比较了高剂量法莫替丁与泮托拉唑预防复发性症状性溃疡/糜烂的疗效。
我们对 160 例阿司匹林相关消化性溃疡/糜烂患者(有或无出血史)进行了一项随机、双盲、对照试验。患者分别给予法莫替丁(40 mg,早晚)或泮托拉唑(20 mg 晨服,安慰剂晚服)。所有患者继续服用阿司匹林(80 mg/d)。主要终点是 48 周内复发性消化不良或出血性溃疡/糜烂。
共有 130 例患者(81.1%)完成了研究;法莫替丁组 65 例患者中有 13 例达到主要终点(20.0%;风险差异的 95%单侧置信区间[CI]为 0.1184-1.0),而泮托拉唑组 65 例患者中无 1 例(P <.0001,风险差异的 95%单侧 CI 为 0.1184-1.0)。法莫替丁组胃肠道出血明显多于泮托拉唑组(7.7%[5/65] vs 0%[0/65];风险差异的 95%单侧 CI 为 0.0226-1.0;P =.0289),溃疡/糜烂所致复发性消化不良也明显多于泮托拉唑组(12.3%[8/65] vs 0%[0/65];风险差异的 95%单侧 CI 为 0.0560-1.0;P =.0031)。无患者发生溃疡穿孔或梗阻。
在阿司匹林相关消化性溃疡/糜烂患者中,高剂量法莫替丁治疗在预防复发性消化不良或出血性溃疡/糜烂方面不如泮托拉唑。