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Evidence summaries

Antisecretory Therapy for Bleeding Peptic Ulcer

Proton pump inhibitors appear to reduce rebleeding in patients with bleeding peptic ulcer. Level of evidence: "B"

A systematic review 1 including 5 RCTs (2 double-blind) with a total of subjects was abstracted in DARE.

Studies without endoscopic therapy (n=3):Omeprazole was associated with a statisticallly significantly lower risk of rebleeding compared with placebo in 1 trial (9% vs 35%). There was a trend toward lower rebleeding rates with omeprazole compared with ranitidine in the second trial (21% vs 39%), and no difference between omeprazole and placebo in the third trial (24% vs 27%).

Studies with endoscopic therapy (n=2): Rebleeding rates were similar where patients were given omeprazole or ranitidine in 1 trial. The second trial showed significantly lower rebleeding rate in patients treated with omeprazole compared with cimetidine (4% vs 24%).

Comment: The quality of evidence is downgraded by potential reporting bias.

    References

    • Peterson WL, Cook DJ. Antisecretory therapy for bleeding peptic ulcer. JAMA 1998 Sep 9;280(10):877-8. [PubMed][DARE]

Primary/Secondary Keywords