A Cochrane review [Abstract] 1 [withdrawn from publication] included 24 studies with a total of 4 373 subjects. There was no significant difference in all-cause mortality rates between proton pump inhibitor (PPI) and control treatment (either placebo or H2-receptor antagonist); pooled rates were 3.9% on PPI versus 3.8% on control (odds ratio [OR] 1.01; 95% CI 0.74 to 1.40). PPI treatment significantly reduced surgery compared with control; pooled rates were 6.1% on PPI versus 9.3% on control (OR 0.61; 95% CI 0.48 to 0.78). PPIs significantly reduced surgery compared with placebo but not when compared with H2RA. PPIs significantly reduced rebleeding compared to control; pooled rates were 10.6% with PPI versus 17.3% with control treatment (OR 0.49; 95% CI 0.37 to 0.65). Results on mortality and rebleeding rates were independent of route of PPI administration, type of control treatment or application of initial endoscopic haemostatic treatment.
Statistical heterogeneity was found among trials for rebleeding (P = 0.04), but not for all-cause mortality (P = 0.24) or surgery (P = 0.45). All-cause mortality was reduced only in Asian studies; reductions in rebleeding and surgery were quantitatively greater in Asian studies. Among patients with active bleeding or non-bleeding visible vessel, PPI treatment reduced mortality (OR 0.53; 95% CI 0.31 to 0.91), rebleeding and surgery.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).
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