Walter L. Peterson, MD
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?
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.
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.
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.
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*
*Abbreviations defined in Glossary. Weighted event rates, RRI, RRR, NNH, NNT, and CI calculated from control event rates and odds ratios in article.
Peterson WL. Review: High-dose and non–high-dose proton pump inhibitors after endoscopic treatment do not differ for bleeding peptic ulcers. Ann Intern Med. 2010;153:JC3–11. doi: 10.7326/0003-4819-153-6-201009210-02011
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Published: Ann Intern Med. 2010;153(6):JC3-11.
Gastroenterology/Hepatology, Peptic Disease, Peptic Ulcer.
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