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PPI for peptic ulcer bleeding

 

Clinical bottom line

Oral and intravenous PPI reduced rebleeding and surgical intervention rates, but nor mortality, which overall was 4.9%.


Reference

GI Leontiadis et al. Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding. BMJ 2005 330: 568-570.

Systematic review

The review searched four electronic registers for randomised trials comparing a proton pump inhibitor with placebo or H2-receptor antagonist for treating ulcer bleeding. Bleeding had to be confirmed endoscopically. Outcomes were mortality, rebleeding, and surgical intervention. The date of the last search was February 2003.

Results

A summary of results according to route of PPI administration is shown in Table 1. Many trials were small. Overall, there was no reduced mortality with PPI, nor by either route separately. PPI use by oral or intravenous routes significantly reduced rebleeding (Figures 1 and 2) and surgical intervention rates. The overall mortality rate was 134/2735 (4.9%).

Table 1: Summary of results by route of administration

Number of
Percent with
Outcome
Route
Trials
Patients
PPI
Control
Relative risk
(95% CI)
NNTp
(95% CI)
Mortality
Oral
5
658
2.6
3.8
0.7 (0.3 to 1.6)
IV
13
2077
6.2
5.1
1.2 (0.9 to 1.7)
Rebleeding
Oral
5
658
10
24
0.4 (0.3 to 0.6)
6.9 (5.0 to 11)
IV
14
2173
11
17
0.6 (0.6 to 0.8)
16 (11 to 37)
Surgical intervention
Oral
5
658
6.5
14
0.4 (0.3 to 0.7)
13 (8.0 to 30)
IV
12
1944
9.1
12
0.7 (0.6 to 0.9)
30 (16 to 165)

 

Figure 1: Rebleeding rates with oral PPI

Figure 2: Rebleeding rates with IV PPI

Comment

Oral and intravenous PPI reduced rebleeding and surgical intervention rates, but nor mortality.