High vs. usual dose PPI after treatment for bleeding ulcer

January 01, 0001

High vs. usual dose PPI after treatment for bleeding ulcer

High-dose proton pump inhibitors (PPIs) (80-mg bolus, followed by 8-mg/h continuous infusion for 72 hours) have been widely studied and used. These Taiwanese authors performed a literature search for randomized controlled trials that compared the use of high-dose PPIs vs non-high-dose PPIs in patients with bleeding peptic ulcer and determined their effects on rebleeding, surgical intervention, and mortality. Outcomes data were combined in a meta-analysis and were reported as odds ratios (ORs).

They found: "A total of 1157 patients from 7 high-quality randomized studies were included in this meta-analysis. High-dose PPIs and non-high-dose PPIs did not differ in their effects on the rates of rebleeding (7 studies and 1157 patients; OR, 1.30), surgical intervention (6 studies and 1052 patients; 1.49), or mortality (6 studies and 1052 patients; 0.89). Post hoc subgroup analyses revealed that summary outcomes measures were unaffected by severity of signs of recent hemorrhage at initial endoscopy, route of PPI administration, or PPI dose."

The authors concluded: "Compared with non-high-dose PPIs, high- dose PPIs do not further reduce the rates of rebleeding, surgical intervention, or mortality after endoscopic treatment in patients with bleeding peptic ulcer."

In light of this study it seems difficult to justify higher cost for high-dose regimens unless that cost is negligible.

For the full abstract, click here.

Arch Intern Med 170(9):751-758, 10 May 2010
© 2010 to the American Medical Association
High-Dose vs Non-High-Dose Proton Pump Inhibitors After Endoscopic Treatment in Patients With Bleeding Peptic Ulcer-A Systematic Review and Meta-analysis of Randomized Controlled Trials. Chih-Hung Wang, Matthew Huei-Ming Ma, Hao-Chang Chou, et al. Correspondence to Dr. Yen: ericyen@ntu.edu.tw

Category: D. Digestive. Keywords: peptic ulcer, upper gastrointestinal bleeding, proton pump inhibitors, PPI, surgical intervention, mortality, meta-analysis of randomized controlled trials, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 25 May 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.