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A 9-year-old child with a diagnosis of juvenile idiopathic arthritis needs to start a non-steroidal anti-inflammatory drug (NSAID) therapy. You are aware of gastrointestinal (GI) adverse effects of NSAIDs and you wonder if it might be worth adding a proton pump inhibitor (PPI).
Structured clinical question
Should children starting long-term NSAID therapy (patients) receive PPI prophylaxis (intervention) to prevent GI adverse events (AEs) (outcome)?
PubMed was searched (2003–2023) using the following terms (‘child’ OR ‘children’ OR ‘paediatric’) AND ‘non-steroidal anti-inflammatory drug’ AND (‘gastric bleeding’ OR ‘duodenal bleeding’ OR ‘gastrointestinal perforation’ OR ‘peptic ulcer’) AND ‘gastropathy prophylaxis’ AND ‘proton pump inhibitor’. Meta-analysis, randomised clinical trial (RCT) and systematic review with the filters ‘English’ and ‘child’ were included. No study was eligible among the eight records that were screened and neither were any clinical trials ongoing (clinical trial.gov on 16 August 2023). Given this, we conducted similar research on adults using: ‘non-steroidal anti-inflammatory drug’ AND ‘(prevention OR prophylaxis)’ AND ‘(gastroduodenal ulcers OR peptic ulcer OR …
Contributors SR, PM and CS contributed equally to the planning, conduct and reporting of the work described in the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.