Hwai-Jeng Lin, MD; Yao-Chun Hsu, MD, MSc
Potential Conflicts of Interest: None disclosed.
Lin H, Hsu Y. Missed Opportunities in the Trial on Proton-Pump Inhibitor Therapy in Bleeding Peptic Ulcers. Ann Intern Med. 2009;151:589. doi: 10.7326/0003-4819-151-8-200910200-00021
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Published: Ann Intern Med. 2009;151(8):589.
TO THE EDITOR:
We would like to comment on the article by Sung and colleagues (1), which reaffirmed the clinical effectiveness of infusional esomeprazole as an adjuvant pharmacotherapy for patients at high risk for bleeding peptic ulcers. First, it is extraordinary that the rebleeding and mortality rates in the placebo recipients were 13.6% and 2.1%, respectively, which are noticeably lower than those in most previous reports. A recent Cochrane meta-analysis (2) revealed a rebleeding rate of 19.2% and a mortality rate of 4.9% in the patients with bleeding ulcers who received placebo. Unfortunately, Sung and colleagues did not explain the discrepancy regarding recurrent bleeding rates, and their explanation for the lower mortality rate was confusing. They argued that the lower-than-expected mortality rate was similar to those reported most recently by Lau and colleagues (3). However, Lau and colleagues aimed to explore the effect of preemptive PPI therapy before endoscopy, and therefore their study comprised heterogeneous patients with bleeding. We do not understand how this study is comparable with the study by Lau and colleagues, in which only 60% of the participants bled from peptic ulcers; moreover, most of them (even the preemptive placebo group) did not have high-risk stigmata.
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