PMID- 15610441
OWN - NLM
STAT- MEDLINE
DCOM- 20050531
LR  - 20131121
IS  - 0815-9319 (Print)
IS  - 0815-9319 (Linking)
VI  - 20
IP  - 1
DP  - 2005 Jan
TI  - Treatment with proton pump inhibitors in acute non-variceal upper 
      gastrointestinal bleeding: a meta-analysis.
PG  - 11-25
AB  - Medical therapy is an attractive adjuvant to endoscopic treatment in upper 
      gastrointestinal (UGI) bleeding. This review aims to assess the treatment effects 
      of proton pump inhibitor (PPI) therapy in acute non-variceal UGI bleeding. 
      Outcome measures evaluated were further bleeding, surgery, all-cause deaths, 
      ulcer deaths and non-ulcer deaths. We searched MEDLINE (1966-2002) and EMBASE 
      (1974-2002) using the terms 'gastrointestinal hemorrhage', 'peptic ulcer 
      hemorrhage', 'proton pump inhibitor', 'omeprazole', 'pantoprazole', 
      'lansoprazole', 'rabeprazole' and 'esomeprazole'. The search was extended to the 
      Cochrane controlled trials registry database, published abstracts from five 
      international gastroenterology conferences, manufacturers of PPI, known contacts 
      and bibliographies from each full-length published report. We included trials 
      published in English and non-English languages. Eligible studies were randomized 
      controlled trials that compared the treatment effects of PPI therapy with placebo 
      or H2 receptor antagonists in patients with acute non-variceal UGI bleeding. Of 
      the 175 articles screened, 26 controlled trials including 4670 subjects (2317 in 
      treatment arm and 2353 in control arm) were analyzed. The methodology, 
      population, intervention, and outcomes of each selected trial were evaluated 
      using duplicate independent review. Disagreements were resolved by consensus. PPI 
      therapy significantly reduced rates of further bleeding (odds ratio [OR], 0.48; 
      95% confidence interval [CI], 0.40-0.57) and surgery (OR, 0.61; 95% CI, 
      0.48-0.76). All-cause deaths were unaffected (OR, 1.02; 95% CI, 0.76-1.37). Ulcer 
      deaths showed a significant reduction (OR, 0.58; 95% CI, 0.35-0.96), while 
      non-ulcer deaths showed a significant increase (OR, 1.60; 95% CI, 1.06-2.41) in 
      the PPI therapy group. Sensitivity analysis of 22 trials published in 
      peer-reviewed journals, 10 trials with double-blind design and 19 trials with 
      high quality score and 22 trials using omeprazole in the treatment group showed 
      results similar to those seen in the analysis of all 26 trials, confirming the 
      stability of the conclusions. Subgroup analysis revealed that summary outcome 
      measures were not influenced by control group therapy (placebo vs H2 receptor 
      antagonists) or the use of prior endoscopic treatment to achieve hemostasis 
      (given vs not given). However, the summary treatment effects for further bleeding 
      and need for surgery were significant in only those trials enrolling patients 
      with peptic ulcers having high risk for rebleeding and not in those trials 
      enrolling patients with all causes of UGI bleeding. The summary treatment effects 
      for further bleeding and need for surgery were significant in trials using 
      intravenous as well as oral PPI. However, summary OR for all-cause deaths and 
      non-ulcer deaths in trials using intravenous PPI were higher in the treatment 
      group and not in trials using oral PPI. This raised the possibility of 
      intravenous PPI-therapy-associated non-ulcer deaths in high-risk patients. PPI 
      therapy in acute non-variceal UGI bleeding reduced rates of further bleeding, 
      surgery and deaths caused by ulcer complications. However, non-ulcer deaths were 
      increased. The overall mortality was unaffected. PPI therapy is useful only in a 
      selected group of patients with acute non-variceal UGI bleeding, namely those 
      with peptic ulcers having endoscopic high-risk stigmata for rebleeding.
FAU - Khuroo, Mohammed S
AU  - Khuroo MS
AD  - Department of Medicine, King Faisal Specialist Hospital and Research Centre, 
      Riyadh, Saudi Arabia. khuroo@yahoo.com
FAU - Khuroo, Mehnaaz S
AU  - Khuroo MS
FAU - Farahat, Karim L C
AU  - Farahat KL
FAU - Kagevi, Ingvar E
AU  - Kagevi IE
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PL  - Australia
TA  - J Gastroenterol Hepatol
JT  - Journal of gastroenterology and hepatology
JID - 8607909
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - J Gastroenterol Hepatol. 2006 Nov;21(11):1763-5. PMID: 16984609
MH  - Acute Disease
MH  - Clinical Trials as Topic
MH  - Gastrointestinal Hemorrhage/*drug therapy
MH  - Humans
MH  - *Proton Pump Inhibitors
RF  - 51
EDAT- 2004/12/22 09:00
MHDA- 2005/06/01 09:00
CRDT- 2004/12/22 09:00
PHST- 2004/12/22 09:00 [pubmed]
PHST- 2005/06/01 09:00 [medline]
PHST- 2004/12/22 09:00 [entrez]
AID - JGH3441 [pii]
AID - 10.1111/j.1440-1746.2004.03441.x [doi]
PST - ppublish
SO  - J Gastroenterol Hepatol. 2005 Jan;20(1):11-25. doi: 
      10.1111/j.1440-1746.2004.03441.x.