PPIs prevent aspirin-induced gastrointestinal bleeding better than H2RAs. A systematic review and meta-analysis

Imre L. Szabó, Robert Mátics, Péter Hegyi, Andras Garami, Anita Illés, Patricia Sarlós, Judit Bajor, Ákos Szűcs, Dóra Mosztbacher, Katalin Márta, Kata Szemes, Kata Csekő, Bálint Kővári, Zoltán Rumbus, Áron Vincze

Research output: Contribution to journalReview article

8 Citations (Scopus)


Background & Aims: Aspirin is one of the most widely used medication for its analgesic and anti-platelet properties and thus a major cause for gastrointestinal (GI) bleeding. This study compared the preventive effect of histamine-2 receptor antagonists (H2RAs) and proton-pump inhibitors (PPIs) against chronic low-dose aspirin (LDA)-related GI bleeding and ulcer formation. Methods: Electronic databases of Pubmed, Embase and Cochrane Central Register of Controlled Trials were searched for human observations (randomised controlled trials and observational studies) comparing the long term effects of PPIs and H2RAs treatment in the prevention of GI bleeding or ulcer formation in patients on chronic LDA treatment listed up till September 30, 2016. Two independent authors searched databases using PICO questions (aspirin, H2RA, PPI, GI bleeding or ulcer), and reviewed abstracts and articles for comprehensive studies keeping adequate study quality. Data of weighted odds ratios were statistically evaluated using Comprehensive Metaanalysis (Biostat, Inc., Engelwood, MJ, USA), potential bias was checked. Results: Nine studies for GI bleeding and eight studies for ulcer formation were found meeting inclusion criteria, altogether 1,879 patients were included into review. The H2RAs prevented less effectively LDA-related GI bleeding (OR= 2.102, 95% CI: 1.008-4.385, p<0.048) and ulcer formation (OR= 2.257, 95% CI: 1.277-3.989, p<0.005) than PPIs. Conclusion: The meta-analysis showed that H2RAs were less effective in the prevention of LDA-related GI bleeding and ulcer formation suggesting the preferable usage of PPIs in case of tolerance.

Original languageEnglish
Pages (from-to)395-402
Number of pages8
JournalJournal of Gastrointestinal and Liver Diseases
Issue number4
Publication statusPublished - Dec 2017


  • Aspirin-induced gastroenteropathy
  • Gastrointestinal bleeding
  • Histamine receptor antagonists
  • Low-dose aspirin treatment
  • Proton pump inhibitors
  • Ulcer

ASJC Scopus subject areas

  • Gastroenterology

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    Szabó, I. L., Mátics, R., Hegyi, P., Garami, A., Illés, A., Sarlós, P., Bajor, J., Szűcs, Á., Mosztbacher, D., Márta, K., Szemes, K., Csekő, K., Kővári, B., Rumbus, Z., & Vincze, Á. (2017). PPIs prevent aspirin-induced gastrointestinal bleeding better than H2RAs. A systematic review and meta-analysis. Journal of Gastrointestinal and Liver Diseases, 26(4), 395-402. https://doi.org/10.15403/jgld.2014.1121.264.hra