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A randomized controlled trial was carried to explore whether omeprazole (proton pump inhibitor) has superior efficacy compared to famotidine (histamine-2 receptor antagonists) to prevent mucosal breaks in 170 high-risk users of low-dose aspirin having a peptic ulcer history and who did not have mucosal breaks at initial endoscopy.
Omeprazole is superior to
famotidine in preventing gastroduodenal mucosal breaks in elevated-risk users
of aspirin. Smoking is an independent and vital risk factor for the development
of gastroduodenal mucosal breaks.
A
randomized controlled trial was carried to explore whether omeprazole
(proton pump inhibitor) has superior efficacy compared to famotidine
(histamine-2 receptor antagonists) to prevent mucosal breaks in 170 high-risk
users of low-dose aspirin having a peptic ulcer history and who did not have
mucosal breaks at initial endoscopy.
Participants were randomly
allocated to receive omeprazole (20 mg once a day, n=86) or famotidine (20 mg
twice daily, n=84) for six months. The follow-up endoscopy was carried at the
end of the sixth month and whenever hematemesis, epigastric discomfort, or
melena occurred. The gastroduodenal mucosal break occurrence was the major
endpoint. Secondary outcomes were the occurrence of gastroduodenal ulcers and
gastroduodenal bleeding.
The incidence of gastroduodenal mucosal breaks was higher in famotidine-recipients compared to omeprazole recipients. The two groups had similar incidence rates of gastroduodenal ulcers, and gastroduodenal bleeding, as depicted below:
The multivariate analysis
demonstrated that proton pump inhibitor use was an independent protective
factor (odds ratio: 0.47). Smoking was found to be a pivotal risk factor for
the occurrence of gastroduodenal mucosal breaks (odds ratio: 3.84).
Proton pump inhibitors have
superior efficacy compared to histamine-2 receptor antagonists in preventing
gastroduodenal mucosal breaks in high-risk aspirin users. For the occurrence of
mucosal breaks, smoking is an independent risk factor.
Journal of the Chinese Medical Association
Omeprazole vs famotidine for the prevention of gastroduodenal injury in high-risk users of low-dose aspirin: A randomized controlled trial
Zhi-Fu Tseng et al.
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