Gastroprotectant Trialists' (GPT) Collaboration
Peptic ulcer disease occurs when the lining of the stomach or the first part of the gut breaks. This can lead to an open sore due to damage from the acid naturally produced by the stomach, which in turn leads to abdominal pain and other symptoms such as indigestion, heartburn and poor appetite. It can also progress to serious, sometimes fatal, complications such as bleeding into the gut from the site of the ulcer (upper gastrointestinal bleeding), part of the stomach or intestine splitting open (perforation) or, rarely, a blockage of the stomach outlet.
The most common causes of peptic ulcer disease are an infection with the bacterium Helicobacter pylori, or taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, particularly if they are taken for a long time or at high doses. As NSAIDs are very widely used many people are potentially at risk of peptic ulcer disease.
Drugs that prevent and treat peptic ulcer disease are often called gastroprotectants. The two most common types are proton pump inhibitors (PPIs) such as omeprazole, and histamine-2 receptor antagonists (H2 blockers) such as cimetidine and ranitidine which reduce the acid produced by the stomach. A third class of drug, a prostaglandin analogue, protects the gut lining.
Although there have been many small clinical trials of gastroprotectant drugs, there has been a lack of reliable information about the effects of these drugs in different clinical situations.
GPT is a large meta-analysis of the effects of gastroprotectants, which combines data from over 1,200 randomised trials including more than 200,000 patients worldwide.
The researchers found that gastroprotectant drugs can more than halve the risk of developing peptic ulcer disease (irrespective of whether NSAIDs, such as ibuprofen or aspirin are also being taken) and more than treble the healing of existing peptic ulcers. In those already experiencing acute upper gastrointestinal bleeding, gastroprotectants reduce the risk of further upper gastrointestinal bleeding by about a third. PPIs generally appear to be superior to other gastroprotectant treatments.
Many gastroprotectants are available cheaply in a generic form but concern about possible heart risks has limited their use, for example in elderly people on aspirin-based therapies following a heart attack, despite the high risk of upper gastrointestinal bleeding in such patients. New trial data will enable any side effects of gastroprotectants to be examined in detail.