Review: High-dose and non–high-dose proton pump inhibitors after endoscopic treatment do not differ for bleeding peptic ulcers

Peterson WL. — Tue, 21 Sep 2010 00:00:00 GMT

Question

In patients with bleeding peptic ulcers, do high-dose proton pump inhibitors (PPIs) after endoscopic treatment reduce recurrent ulcer bleeding, surgical intervention, or mortality more than non–high-dose PPIs?

Review scope

Included studies compared high-dose PPIs with non–high-dose PPIs after endoscopic intervention in patients with endoscopically confirmed bleeding peptic ulcers. Doses of PPIs equivalent to 80-mg boluses of omeprazole or pantoprazole followed by continuous intravenous infusion of drug at 8 mg/h for 72 hours or continuous infusion doses > 192 mg/d were considered high. Outcomes were endoscopically confirmed recurrent ulcer bleeding within 30 days of randomization, surgical intervention, and all-cause mortality.

Review methods

MEDLINE, EMBASE/Excerpta Medica, BioMedCentral, CINAHL, Cochrane Central Register of Controlled Trials (Aug 2009), and reference lists were searched for randomized controlled trials (RCTs) with methodological quality ≥ 3 on the 5-point Jadad scale. 7 RCTs (n = 1157, mean age 62 y, 66% men) met the selection criteria. The number of patients in each study ranged from 25 to 474. 3 trials studied omeprazole, 3 used pantoprazole, and 1 used both; 2 studies were multicenter, and 3 were double-blind.

Main results

Meta-analysis showed that groups did not differ for recurrent ulcer bleeding, surgical intervention, or mortality (Table). There was no significant statistical heterogeneity (I² = 0%; P = 0.74 to 0.90) across study results for any of the outcomes.

Conclusion

In patients with bleeding peptic ulcers, high-dose proton pump inhibitors and non–high-dose proton pump inhibitors after endoscopic treatment do not differ for recurrent ulcer bleeding, surgical intervention, or mortality.High-dose vs non–high-dose proton pump inhibitors (PPIs) for bleeding peptic ulcers*OutcomesNumber of trials (n)Weighted event ratesRRI (95% CI)NNH (CI)High-dose PPIsNon–high-dose PPIsRecurrent ulcer bleeding at 30 d7 (1157)13%10%26% (−11 to 75)Not significantSurgical intervention6 (1052)2.6%1.7%48% (−34 to 224)Not significantRRR (CI)NNT (CI)All-cause mortality at 30 d or in hospital6 (1052)1.9%2.1%11% (−108 to 62)Not significant*Abbreviations defined in Glossary. Weighted event rates, RRI, RRR, NNH, NNT, and CI calculated from control event rates and odds ratios in article.

Annals of Internal Medicine: Peptic Ulcer Topic Collection

Review: High-dose and non–high-dose proton pump inhibitors after endoscopic treatment do not differ for bleeding peptic ulcers