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Review: misoprostol, double dose H2 receptor antagonists, and proton pump inhibitors reduce GI ulcers in long term NSAID use

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 QUESTION: In patients requiring long term non-steroidal anti-inflammatory drugs (NSAIDs), are prostaglandin analogues (PAs), H2 receptor antagonists (H2RAs), and proton pump inhibitors (PPIs) effective at reducing NSAID induced gastrointestinal (GI) ulcers?

Data sources

Studies were identified by searching Medline (1966 to January 2000) and EMBASE/Excerpta Medica (to February 1999), the Cochrane Controlled Trials Register (1973–99), current contents (6 mo before January 2000), and conference proceedings; by reviewing bibliographies of retrieved studies, including reviews; and through personal contact with experts and companies.

Study selection

2 reviewers independently selected randomised controlled trials published in any language. Studies were selected if they examined PA, H2RA, or PPI effects on preventing NSAID induced upper GI toxicity in adults; if the duration of NSAID exposure was >3 weeks; and if endoscopic ulcers were ≥3 mm in …

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  • NNT and CI calculated from data in reference 1.


  • Source of funding: no external funding.

  • For correspondence: Dr A Rostom, Division of Gastroenterology, Ottawa Hospital-Civic Site, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. Fax +1 613 761 5068.