PMID- 17054257
OWN - NLM
STAT- MEDLINE
DCOM- 20070119
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 4
DP  - 2006 Oct 18
TI  - Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper 
      gastrointestinal bleeding.
PG  - CD005415
AB  - BACKGROUND: There is conflicting evidence regarding the clinical efficacy of 
      proton pump inhibitors (PPI) initiated prior to endoscopy in patients with upper 
      gastrointestinal bleeding. OBJECTIVES: We aimed to systematically review evidence 
      from randomised controlled trials (RCTs) that studied PPI treatment initiated 
      before endoscopy in patients with upper gastrointestinal bleeding. SEARCH 
      STRATEGY: A search was undertaken according to the Cochrane Upper 
      Gastrointestinal and Pancreatic Diseases model using CENTRAL, (The Cochrane 
      Library), MEDLINE, EMBASE and CINAHL databases and major conference proceedings 
      up to September 2005. The literature search was re-run in February 2006. 
      SELECTION CRITERIA: Types of studies: Randomised controlled trials (RCTs). TYPES 
      OF PARTICIPANTS: Hospitalised patients with unselected upper gastrointestinal 
      bleeding. Types of interventions: Active treatment with a PPI (oral or 
      intravenous) and control treatment with either placebo or an histamine-(2) 
      receptor antagonist (H(2)RA). Types of outcome measures: Assessed at 30 days: 
      mortality, rebleeding and surgery. Also assessed were stigmata of recent 
      haemorrhage at index endoscopy, length of hospital stay and blood transfusion 
      requirements. DATA COLLECTION AND ANALYSIS: At least two reviewers assessed the 
      eligibility criteria of each study and extracted data regarding outcomes and 
      factors affecting methodological quality. MAIN RESULTS: Five RCTs were included 
      for review. No further RCTS were identified in an updated literature search. Four 
      trials comprising a total of 1512 patients in total reported data for all 
      randomised patients. There was no statistical heterogeneity among trials for the 
      outcomes of mortality, rebleeding and surgery. 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 
      (odds ratio (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). For the continuous outcomes, 
      namely length of hospital stay and blood transfusion requirements, quantitative 
      analysis could not be performed. AUTHORS' CONCLUSIONS: PPI treatment initiated 
      prior to endoscopy in patients with upper gastrointestinal bleeding significantly 
      reduces the proportion of patients with stigmata of recent haemorrhage at index 
      endoscopy. However, there is no evidence that PPI treatment affects clinically 
      important outcomes, namely mortality, rebleeding or need for surgery.
FAU - Dorward, S
AU  - Dorward S
AD  - Leeds General Infirmary, Gastroenterology, Great George Street, Leeds, West 
      Yorkshire, UK
FAU - Sreedharan, A
AU  - Sreedharan A
FAU - Leontiadis, G I
AU  - Leontiadis GI
FAU - Howden, C W
AU  - Howden CW
FAU - Moayyedi, P
AU  - Moayyedi P
FAU - Forman, D
AU  - Forman D
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20061018
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
UIN - Cochrane Database Syst Rev. 2010;(7):CD005415. PMID: 20614440
MH  - Anti-Ulcer Agents/*therapeutic use
MH  - Endoscopy, Gastrointestinal
MH  - Gastrointestinal Hemorrhage/*drug therapy/mortality
MH  - Humans
MH  - *Proton Pump Inhibitors
MH  - Randomized Controlled Trials as Topic
MH  - Recurrence
RF  - 71
EDAT- 2006/10/21 09:00
MHDA- 2007/01/20 09:00
CRDT- 2006/10/21 09:00
PHST- 2006/10/21 09:00 [pubmed]
PHST- 2007/01/20 09:00 [medline]
PHST- 2006/10/21 09:00 [entrez]
AID - 10.1002/14651858.CD005415.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005415. doi: 
      10.1002/14651858.CD005415.pub2.