Primary gastroduodenal prophylaxis with omeprazole for non‐steroidal anti‐inflammatory drug users

Aim: To investigate the efficacy of omeprazole 20 mg o.m. as primary prophylaxis against non‐steroidal anti‐inflammatory drug (NSAID)‐associated ulcer disease or dyspeptic symptoms. Methods: A parallel group study compared patients randomized to receive omeprazole 20 mg o.m. or placebo as co‐therapy with on‐going NSAID treatment, over 6 months, in 19 specialist centres in Ireland, Hungary, France, the UK and the USA. One hundred and sixty‐nine patients taking NSAIDs regularly, chronically and above defined minimum doses entered the trial. The main outcome measure was the development of gastric or duodenal ulcers detected endoscopically, the development of multiple erosions in the stomach or duodenum, or the onset of moderate or severe dyspeptic symptoms. Results: The estimated probability of remaining free of these end‐points for 6 months for patients taking omeprazole was 0.78 compared to 0.53 for placebo ( P = 0.004). Fourteen patients receiving placebo (16.5%) developed 15 ulcers, comprising nine gastric and six duodenal ulcers, compared to three patients (3.6%) receiving omeprazole (all gastric ulcers). Logistic regression analysis showed that older patients were less likely, whilst those with rheumatoid arthritis were more likely, to remain free of NSAID‐associated problems. Conclusions: Omeprazole is an effective agent for gastroduodenal prophylaxis in patients taking NSAIDs. Its main effect is to reduce the rate of development of gastric and duodenal ulcers.