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Evidence summaries

Comparison of Different Regimens of Proton Pump Inhibitors for Acute Peptic Ulcer Bleeding

High dose and medium to low dose proton pump inhibitors may be equally effective in the treatment of acute peptic ulcer bleeding. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding).

Summary

A Cochrane review [Abstract] 1 included 22 studies with a total of 2388 participants. Patients with acute upper GI bleeding with an endoscopically-confirmed diagnosis of bleeding peptic ulcer were included. The participants were patients admitted to hospital for the bleeding episode or in-patients who developed acute bleeding from a peptic ulcer while hospitalized for other reasons. The studies were categorized based on the cumulative dose of PPI received within the first 72 hours of treatment as follows:

  • "low-dose" studies: 120 mg or less/72 hours
  • "medium-dose" studies: 121 to 599 mg/72 hours
  • "high-dose" studies: 600 mg or higher/72 hours.

Results of the main comparisons are given in table 1.

OutcomeNumber of participants (studies)Assumed risk*Medium/low dose PPICorresponding riskHigh dose PPIRelative effect
Mortality1667 (12)3 per 1003 per 100(2 to 5)RR 0.85 (0.47 to 1.54)
Re-bleeding1716 (13)9 per 10011 per 100(9 to 14)RR 1.27 (0.96 to 1.67)
Surgery1270 (9)2 per 1003 per 100(1 to 4)RR 1.33(0.63 to 2.77)
Length of hospital stay1069 (6) The mean length of hospital stay was0.26 higher(0.08 lower to 0.6 higher)
Further endoscopic treatment902 (9)7 per 1009 per 100(6 to 12)RR 1.39(0.88 to 2.18)
* Median control group risk across studies

Clinical comments

Note

Date of latest search:

    References

    • Neumann I, Letelier LM, Rada G et al. Comparison of different regimens of proton pump inhibitors for acute peptic ulcer bleeding. Cochrane Database Syst Rev 2013;6():CD007999. [PubMed]

Primary/Secondary Keywords