Proton pump inhibitors in bleeding peptic ulcer: a meta-analysis

Sheppard, Duane (2006) Proton pump inhibitors in bleeding peptic ulcer: a meta-analysis. Masters thesis, Memorial University of Newfoundland.

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Abstract

Introduction: The purpose of this meta-analysis was to determine the efficacy of proton pump inhibitors (PPI) in preventing recurrent bleeding and death in bleeding peptic ulcer. -- Methods: PubMed and hand searching of cited references was used to identify relevant studies comparing PPI to either placebo or histamine 2 receptor antagonists for the prevention of rebleeding or death. Non English studies were translated Quality assessment and data extraction was performed by 2 independent reviewers. The RevMan statistical software was used to combine studies with the peto method. -- Results: 15 studies with a total of3063 patients enrolled were included. The pooled Odds Ratio(pOR) for the use of PPI to prevent rebleeding was significant at 0.55 (95%CI 0.46-0.66). There was a reduction in rebleeding regardless of whether or not therapeutic endoscopy had been used. Infusions of PPI were most beneficial with a pOR of0.40 (0.29-53) with a number needed to treat to prevent 1 rebleed of only5 while bolus injections failed to provide any benefit over control medication. There was no difference in mortality between PPI and control groups. -- Discussion: PPI are effective for the prevention of rebleeding in peptic ulcer disease regardless of whether or not therapeutic endoscopy has been employed. PPI are most effective when given as an infusion. Intravenous PPI should only be used in high risk peptic ulcer bleeding. Further investigations are required to determine the role of oral PPI for the prevention of rebleeding as only 2 studies used oral PPI.

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