A meta-analysis 3 including 21 RCTs with a total of 2 915 patients found that proton pump inhibitors had no significant effect on mortality (OR 1.11, 95% CI 0.79 to 1.57 for all studies, OR 0.96, 95% CI 0.46 to 2.01 in the 10 studies with adequate concealment of allocation). Proton pump inhibitors reduced rebleeding (OR 0.46, 95% CI 0.33 to 0.64, NNT = 12) and surgery (OR 0.59, 95% CI 0.46 to 0.76, NNT = 20).
A systematic review 1 including 16 studies with a total of 3 154 subjects was abstracted in DARE. In the 11 studies in which endoscopic therapy was not administered, the rebleeding rate in the control groups had a very wide range, from 1.5 to 85%. Omeprazole, however, was generally associated with lower rates of rebleeding, ranging from 0 to 24%; this attained statistical significance in 3 studies. In the 5 studies that used concomitant initial endoscopic therapy in both arms, rebleeding rates in the control groups ranged from 17 to 24%. The active therapy groups again showed a generally lower rebleeding rate, ranging from 4 to 26%. Only one of these studies reached statistical significance. Three studies described the incidence of recurrent bleeding based on endoscopic criteria, e.g. stigmata of recent haemorrhage, which can be important, independent predictors of recurrent ulcer bleeding. Two of the studies reported statistically-significant results in terms of a decreased bleeding rate (p <0.001 and p <0.05), particularly with type IIa and IIb ulcers from the Forrest Classification (non-bleeding visible vessels or clots).
None of the studies demonstrated a significant mortality reduction.
The following decision support rules contain links to this evidence summary:
Primary/Secondary Keywords