Thématique :
- Œsophage/Estomac
Originalité :
Solidité :
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Florian ROSTAIN
Coup de coeur :
  2016 Sep 15. pii: S0016-5085(16)35031-4  
  doi: 10.1053/j.gastro.2016.09.006  
  Similar Efficacy of Proton-Pump Inhibitors vs H2-Receptor Antagonists in Reducing Risk of Upper Gastrointestinal Bleeding or Ulcers in High-risk Users of Low-dose Aspirin  
  Chan FK, Kyaw M, Tanigawa T, Higuchi K, Fujimoto K, Cheong PK, Lee V, Kinoshita Y, Naito Y, Watanabe T, Ching JY, Lam K, Lo A, Chan H, Lui R, Tang RS, Sakata Y, Tse YK, Takeuchi T, Handa O, Nebiki H, Wu JC, Abe T, Mishiro T, Ng SC, Arakawa T  

Background & Aims

It is not clear whether H2-receptor antagonists (H2RAs) reduce the risk of gastrointestinal (GI) bleeding in aspirin users at high risk. We performed a double-blind randomized trial to compare the effects of a proton pump inhibitor (PPI) vs a H2RA antagonist in preventing recurrent upper gastrointestinal (GI) bleeding and ulcers in high-risk aspirin users.


We studied 270 users of low-dose aspirin (325 mg or less per day) with a history of endoscopically confirmed ulcer bleeding at 8 sites in Hong Kong and Japan. After healing of ulcers, subjects with negative results from tests for Helicobacter pylori resumed aspirin (80 mg) daily and were randomly assigned to groups given a once daily PPI (rabeprazole, 20 mg, n=138) or H2RA (famotidine, 40 mg, n=132) for up to 12 months. Subjects were evaluated every 2 months; endoscopy was repeated if they developed symptoms of upper GI bleeding or had a reduction in hemoglobin >2 gram/decilitre and after 12 months of follow up. The adequacy of upper GI protection was assessed by endpoints of recurrent upper GI bleeding and a composite of recurrent upper GI bleeding or recurrent endoscopic ulcers at month 12.


During the 12-month study period, upper GI bleeding recurred in 1 patient receiving rabeprazole (0.7%; 95% CI, 0.1% to 5.1%) and 4 receiving famotidine (3.1%, 95% CI, 1.2%–8.1%) (P=.16). The composite endpoint of recurrent bleeding or endoscopic ulcers at month 12 was reached by 9 patients receiving rabeprazole (7.9%; 95% CI, 4.2%–14.7%) and 13 receiving famotidine (12.4%; 95% CI, 7.4%–20.4%) (P=.26).


In a randomized controlled trial of users of low-dose aspirin at risk for recurrent GI bleeding, a slightly lower proportion of patients receiving a PPI along with aspirin developed recurrent bleeding or ulcer than of patients receiving an H2RA with the aspirin, although this different was not statistically significant. no: NCT01408186.

Question posée
Les IPP sont-ils plus efficaces que les anti-H2 pour prévenir la récidive d’une hémorragie digestive haute ou un d’ulcère chez des patients à haut risque traités par aspirine ?
Question posée
Etude Japonaise multicentrique double aveugle chez des patients ayant déjà eu un ulcère hémorragique, et traité par aspirine à faible dose. Un groupe IPP prophylactique (rabeprazole, 20 mg, n=138) ; un groupe anti-H2 prophylactique (famotidine, 40 mg, n=132). A un an, une récidive hémorragique est survenue chez un patient du groupe IPP contre 4 patients dans le groupe anti-H2 (p : 0,16). La récidive hémorragique ou bien la récidive d’un ulcère dans les 12 mois survenaient chez 9 patients du groupe IPP et 13 patients du groupe anti-H2 (p : 0,26).

Ces résultats ne sont pas significatifs cependant les effectifs des 2 groupes restent relativement faibles ce qui explique peut-être qu’une différence significative n’ai pas été mise en évidence.