CLINICAL QUESTION

Are proton pump inhibitors (PPIs) effective for preventing dyspepsia and gastric or duodenal ulcers in people with long-term nonsteroidal anti-inflammatory drug (NSAID) consumption?

EVIDENCE-BASED ANSWER

PPIs slightly reduce symptoms of dyspepsia and improve quality of life for people taking NSAIDs long-term compared with placebo. PPIs also decrease incident gastric and duodenal ulcers vs placebo. It is unclear if PPIs are effective for preventing gastric and duodenal ulcers compared with histamine H₂ blockers or misoprostol, or if there is any difference in adverse events compared with placebo or other drugs.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

PRACTICE POINTERS

NSAIDs comprise 5% to 10% of all prescriptions and often are used long-term to treat inflammation or pain. Adverse effects of long-term NSAID use include gastrointestinal toxicity, ranging in severity from dyspepsia to gastric or duodenal ulcers, ulcer bleeding, and perforation. NSAIDs inhibit protective gastric prostaglandins and interfere with mucosal integrity.² PPIs provide gastroprotective effects by decreasing gastric acid secretion. The authors of this review aimed to assess the effects of PPIs on the prevention of dyspepsia and gastric or duodenal ulcers in people who used NSAIDs long-term (ie, at least 4 weeks).¹