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.