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Do PPIs Protect Aspirin Users in East Asia from Ulcer Recurrence?

Summary and Comment |
January 2, 2014

Do PPIs Protect Aspirin Users in East Asia from Ulcer Recurrence?

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Apparently, yes — as has been shown in studies of Western populations

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Low-dose aspirin therapy is associated with an increased risk for peptic ulcer disease. In studies of Western populations, proton-pump inhibitors (PPIs) have been shown to reduce this risk. However, physiologic differences between Western and East Asian populations — including the rate of polymorphisms of cytochrome P450 enzymes that metabolize PPIs — might result in variable efficacy.

To assess the efficacy of PPIs to prevent ulcer recurrence in an East Asian population, researchers randomized 364 patients at 57 locations in Japan, Korea, and Taiwan to receive esomeprazole (20 mg/day) or placebo in a double-blind study. All patients had endoscopic documentation of past peptic ulcer disease and were currently taking low-dose aspirin (81–324 mg/day) for prevention of thrombosis. Patients underwent endoscopic evaluations at 12-week intervals. All patients also took gefarnate (50 mg twice daily) for gastric protection. Data analyzed were from the first 48 weeks of the 2-year study.

Compared with placebo, esomeprazole was protective against ulcer recurrence (hazard ratio, 0.09; 96.65% confidence interval, 0.02–0.41). At 48 weeks, 98% of patients taking esomeprazole and 81% of patients taking placebo remained ulcer-free.

Comment

The authors conclude that esomeprazole reduces the recurrence of peptic ulcers in East Asian patients who have a prior history of ulcers and take low-dose aspirin. These results confirm the generalizability of previous studies that demonstrated an association between proton-pump inhibitors and reduced occurrence of peptic ulcers in patients taking aspirin or nonsteroidal anti-inflammatory drugs. The current finding is not surprising considering that PPIs have been shown effective in similar studies in Hong Kong and are effective in preventing rebleeding from peptic ulcers in Asian populations.

  • Disclosures for David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) at time of publication Leadership positions in professional societies World Gastroenterology Organization (Treasurer)

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