Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
United European Gastroenterol J. 2023 Nov;11(9):861-873. doi: 10.1002/ueg2.12448. Epub 2023 Aug 8.
Several studies have suggested that the mucosal protective effects of proton pump inhibitors (PPIs) do not extend beyond the duodenum; however, PPIs may cause lower gastrointestinal (LGI) injury, although these relationships have not yet been fully elucidated.
We searched all the relevant studies published until September 2022 that examined the risk of PPIs for LGI bleeding. We performed a meta-analysis of the risk of LGI bleeding (small bowel (SB) or colorectal bleeding) between PPI users and non-users. A subgroup analysis of patients consuming aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) was also performed.
Twelve studies with 341,063 participants were included in this meta-analysis. The use of PPIs was associated with the risk of LGI bleeding (odds ratio [OR] [95% confidence interval [CI]] = 1.42 [1.16-1.73]; hazard ratio [HR] [95% CI] = 3.23 [1.56-6.71]). An association between PPI use and the risk of LGI bleeding was also identified in the subgroup of aspirin or NSAID users (OR [95% CI] = 1.64 [1.49-1.80]; HR [95% CI] = 6.55 [2.01-21.33]). In the bleeding site-specific analyses, the risk of SB bleeding was associated with PPI use (OR [95% CI] = 1.54 [1.30-1.84]).
PPI use was associated with an increased risk of LGI bleeding, particularly SB bleeding. This association was particularly pronounced among aspirin and NSAID users. Inappropriate PPI prescriptions should be avoided in patients with LGI bleeding and a low risk of upper gastrointestinal disease.
多项研究表明质子泵抑制剂（PPIs）的黏膜保护作用并不延伸至十二指肠以外；然而，PPIs 可能会导致下胃肠道（LGI）损伤，尽管这些关系尚未完全阐明。
我们搜索了截至 2022 年 9 月发表的所有相关研究，这些研究检查了 PPI 用于 LGI 出血的风险。我们对 PPI 使用者和非使用者之间 LGI 出血（小肠（SB）或结直肠出血）的风险进行了荟萃分析。还对服用阿司匹林或非甾体抗炎药（NSAIDs）的患者进行了亚组分析。
本荟萃分析纳入了 12 项研究，共 341063 名参与者。使用 PPI 与 LGI 出血风险相关（比值比[OR] [95%置信区间[CI]]=1.42 [1.16-1.73]；风险比[HR] [95% CI] = 3.23 [1.56-6.71]）。在服用阿司匹林或 NSAIDs 的亚组中，也发现了 PPI 使用与 LGI 出血风险之间的关联（OR [95% CI] = 1.64 [1.49-1.80]；HR [95% CI] = 6.55 [2.01-21.33]）。在出血部位特异性分析中，SB 出血与 PPI 使用相关（OR [95% CI] = 1.54 [1.30-1.84]）。
PPI 使用与 LGI 出血风险增加相关，特别是 SB 出血。这种关联在服用阿司匹林和 NSAIDs 的患者中更为明显。在 LGI 出血风险低且上胃肠道疾病风险低的患者中，应避免不合理的 PPI 处方。
