High-dose vs low-dose proton pump inhibitors for upper gastrointestinal bleeding: a meta-analysis.

Abstract

AIM:

To evaluate the efficacy of high-dose proton pump inhibitors (PPIs) vs low-dose PPIs for patients with upper gastrointestinal bleeding.

METHODS:

PubMed, Embase, the Cochrane Library, and Web of Science were searched to identify relevant randomized controlled trials (RCTs). Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis. The primary endpoint was rebleeding; secondary endpoints were patient numbers that needed surgery, and mortality. The meta-analysis was performed with a fixed effects model or random effects model.

RESULTS:

Nine eligible RCTs including 1342 patients were retrieved. The results showed that high-dose intravenous PPI was not superior to low-dose intravenous PPI in reducing rebleeding [odds ratio (OR) = 1.091, 95% confidential interval (CI): 0.777-1.532], need for surgery (OR = 1.522, 95% CI: 0.643-3.605) and mortality (OR = 1.022, 95% CI: 0.476-2.196). Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients (OR = 0.831, 95% CI, 0.467-1.480) and European patients (OR = 1.263, 95% CI: 0.827-1.929).

CONCLUSION:

Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.

• Authors: Liu-Cheng Wu, Yun-Fei Cao, Jia-Hao Huang, Cun Liao, Feng Gao
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 16 Issue 20 Pg. 2558-65 (May 28 2010) ISSN: 2219-2840 [Electronic] United States
• PMID: 20503458 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)

Chemical References

• Proton Pump Inhibitors

Topics

• Databases, Factual
• Dose-Response Relationship, Drug
• Gastrointestinal Hemorrhage (drug therapy, mortality, prevention & control, surgery)
• Hemostasis, Endoscopic
• Humans
• Proton Pump Inhibitors (therapeutic use)
• Randomized Controlled Trials as Topic
• Recurrence
• Upper Gastrointestinal Tract (pathology, surgery)