Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu, China.
Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
Clin Transl Gastroenterol. 2023 Jun 1;14(6):e00588. doi: 10.14309/ctg.0000000000000588.
Conflicting results exist on the association between proton-pump inhibitor (PPI) and nonsteroidal anti-inflammatory drug (NSAID)-related small-bowel damage. The aim of this study was to determine whether PPIs increased the risk of NSAID-related small-bowel damage by meta-analysis.
A systematic electronic search in PubMed, Embase, and Web of Science was conducted from the time the database was created until March 31, 2022, for studies reporting associations between PPI use and outcomes, including the endoscopy-verified prevalence of small-bowel injury, mean number of small-bowel injuries per patient, change in hemoglobin level, and risk of small-bowel bleeding in subjects taking NSAIDs. Meta-analytical calculations for odds ratio (OR) and mean difference (MD) were performed with the random-effects model and interpreted with 95% confidence intervals (CIs).
Fourteen studies comprising 1996 subjects were included. Pooled analysis demonstrated that concomitant use of PPIs significantly increased the prevalence and number of endoscopy-verified small-bowel injuries (prevalence: OR = 3.00; 95% CI: 1.74-5.16; number: MD = 2.30; 95% CI: 0.61-3.99) and decreased hemoglobin levels (MD = -0.50 g/dL; 95% CI: 0.88 to -0.12) in NSAID users but did not change the risk of small-bowel bleeding (OR = 1.24; 95% CI: 0.80-1.92). Subgroup analysis demonstrated that PPIs significantly increased the prevalence of small-bowel injury in subjects taking nonselective NSAIDs (OR = 7.05; 95% CI: 4.70-10.59, 4 studies, I 2 = 0) and COX-2 inhibitors (OR = 4.00; 95% CI: 1.18-13.60, 1 study, no calculated I 2 ) when compared with COX-2 inhibitors alone.
PPIs increased the risk of NSAID-related small-bowel damage, and the clinical significance of higher prevalence of small-bowel injuries should be studied in the future.
质子泵抑制剂 (PPI) 和非甾体抗炎药 (NSAID) 相关小肠损伤之间的关联存在相互矛盾的结果。本研究旨在通过荟萃分析确定 PPI 是否会增加 NSAID 相关小肠损伤的风险。
从数据库创建到 2022 年 3 月 31 日，在 PubMed、Embase 和 Web of Science 中进行了系统的电子搜索，以检索报告 PPI 使用与结局之间关联的研究，结局包括内镜证实的小肠损伤发生率、每位患者的小肠损伤平均数量、血红蛋白水平变化和 NSAID 使用者小肠出血风险。使用随机效应模型进行比值比 (OR) 和平均差 (MD) 的荟萃分析计算，并使用 95%置信区间 (CI) 进行解释。
纳入了 14 项包含 1996 名受试者的研究。汇总分析表明，PPI 的同时使用显著增加了 NSAID 使用者内镜证实的小肠损伤发生率和数量（发生率：OR = 3.00；95%CI：1.74-5.16；数量：MD = 2.30；95%CI：0.61-3.99）和降低血红蛋白水平（MD = -0.50 g/dL；95%CI：0.88-0.12），但并未改变小肠出血风险（OR = 1.24；95%CI：0.80-1.92）。亚组分析表明，与单独使用 COX-2 抑制剂相比，PPI 显著增加了非选择性 NSAIDs（OR = 7.05；95%CI：4.70-10.59，4 项研究，I 2 = 0）和 COX-2 抑制剂（OR = 4.00；95%CI：1.18-13.60，1 项研究，未计算 I 2 ）使用者小肠损伤的发生率。
PPI 增加了 NSAID 相关小肠损伤的风险，未来应研究小肠损伤发生率较高的临床意义。
