section name header

Evidence summaries

Proton Pump Inhibitor Treatment Initiated Prior to Endoscopic Diagnosis in Upper Gastrointestinal Bleeding

PPI treatment before endoscopy appears not to be effective for clinically important outcomes, such as mortality, rebleeding or need for surgery, although it reduces the proportion of patients with stigmata of recent haemorrhage at index endoscopy. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 6 studies with a total of 2 223 subjects. There were no statistically significant differences in rates of mortality, rebleeding or surgery between PPI and control treatment. Pooled mortality rates were 6.1% and 5.5% respectively (OR 1.12; 95% CI 0.72 to 1.73). Pooled rebleeding rates were 13.9% and 16.6% respectively (OR 0.81; 95%CI 0.61 to 1.09). Pooled rates for surgery were 9.9% and 10.2% respectively (OR 0.96 95% CI 0.68 to 1.35). PPI treatment compared to control significantly reduced the proportion of patients with stigmata of recent haemorrhage at index endoscopy; pooled rates were 37.2% and 46.5% respectively (OR 0.67; 95% CI 0.54 to 0.84). PPI treatment compared to control significantly reduced endoscopic therapy at index endoscopy; pooled rates were 8.6% and 11.7% respectively (OR 0.68; 95% CI 0.50 to 0.93).

Comment: The quality of evidence is downgraded by indirectness (differences in reported outcomes).

    References

    • Dorward S, Sreedharan A, Leontiadis GI, Howden CW, Moayyedi P, Forman D. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev 2006 Oct 18;(4):CD005415 [Review content assessed as up-to-date: 27 October 2009]. [PubMed]

Primary/Secondary Keywords