PMID- 20614440 OWN - NLM STAT- MEDLINE DCOM- 20100811 LR - 20220311 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 2010 IP - 7 DP - 2010 Jul 7 TI - Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. PG - CD005415 LID - 10.1002/14651858.CD005415.pub3 [doi] LID - CD005415 AB - BACKGROUND: There is conflicting evidence regarding the clinical efficacy of proton pump inhibitors (PPI) initiated before endoscopy for upper gastrointestinal bleeding. OBJECTIVES: To systematically review evidence from randomised controlled trials (RCTs) of PPI treatment initiated before endoscopy for upper gastrointestinal bleeding. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE and CINAHL databases and major conference proceedings to September 2005, using the Cochrane Upper Gastrointestinal and Pancreatic Diseases model. Searches were re-run in February 2006 and October 2008. SELECTION CRITERIA: We selected randomised controlled trials (RCTs), of hospitalised participants with unselected upper gastrointestinal bleeding, undergoing active treatment with a proton pump inhibitor PPI (oral or intravenous) and control treatment with either placebo, histamine-2 receptor antagonist (H2RA) or no treatment prior to endoscopy. Outcomes were assessed at 30 days and included mortality, rebleeding and surgery. Also assessed were stigmata of recent haemorrhage (SRH; active bleeding, non bleeding visible vessel or adherent clot) at index endoscopy, length of hospital stay, blood transfusion requirements and requirement for endoscopic therapy at index endoscopy. DATA COLLECTION AND ANALYSIS: At least two review authors assessed eligibility criteria and extracted data regarding outcomes and factors affecting methodological quality. MAIN RESULTS: Six RCTs comprising 2223 participants were included. There was no statistical heterogeneity among trials for dichotomous outcomes. There were no statistically significant differences in mortality, rebleeding or surgery between PPI and control treatment. Unweighted pooled mortality rates were 6.1% and 5.5% respectively (odds ratio (OR)1.12; 95% CI 0.72 to 1.73). Unweighted 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 participants with SRH at index endoscopy; unweighted pooled rates were 37.2% and 46.5% respectively (OR 0.67; 95% CI 0.54 to 0.84). However, this result was not robust to sensitivity analysis. PPI treatment compared to control significantly reduced endoscopic therapy at index endoscopy; unweighted pooled rates were 8.6% and 11.7% respectively (OR 0.68; 95% CI 0.50 to 0.93). For continuous outcomes (length of hospital stay and blood transfusion requirements), quantitative analysis could not be performed. AUTHORS' CONCLUSIONS: PPI treatment initiated before endoscopy for upper gastrointestinal bleeding might reduce the proportion of participants with SRH at index endoscopy and significantly reduces requirement for endoscopic therapy during index endoscopy. However, there is no evidence that PPI treatment affects clinically important outcomes, namely mortality, rebleeding or need for surgery. FAU - Sreedharan, Aravamuthan AU - Sreedharan A AD - Department of Gastroenterology, United Lincolnshire Hospitals NHS Trust, Lincoln County Hospital, Greetwell Road, Lincoln, Lincolnshire, UK, LN2 2YE. FAU - Martin, Janet AU - Martin J FAU - Leontiadis, Grigorios I AU - Leontiadis GI FAU - Dorward, Stephanie AU - Dorward S FAU - Howden, Colin W AU - Howden CW FAU - Forman, David AU - Forman D FAU - Moayyedi, Paul AU - Moayyedi P LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20100707 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 RN - 0 (Anti-Ulcer Agents) RN - 0 (Histamine H2 Antagonists) RN - 0 (Proton Pump Inhibitors) SB - IM UOF - Cochrane Database Syst Rev. 2006;(4):CD005415. PMID: 17054257 CIN - Evid Based Med. 2011 Feb;16(1):13-4. PMID: 21081630 CIN - Ann Emerg Med. 2014 Jun;63(6):759-60. PMID: 24199839 UIN - Cochrane Database Syst Rev. 2022 Jan 7;1:CD005415. PMID: 34995368 MH - Anti-Ulcer Agents/*therapeutic use MH - *Endoscopy, Gastrointestinal MH - Gastrointestinal Hemorrhage/*drug therapy/mortality MH - Histamine H2 Antagonists/therapeutic use MH - Humans MH - Proton Pump Inhibitors MH - Randomized Controlled Trials as Topic MH - Recurrence PMC - PMC6769021 COIS- A Sreedharan - Has received speaker fees from Astra Zeneca and has accepted honoraria from Abbott for attending scientific meetings Janet Martin - co-investigator in a partner grant between industry (Astra Zeneca) and CIHR, but does not receive any payment from this grant. G Leontiadis - Has received speaker fees and reimbursement for expenses to attend scientific meetings from AstraZeneca, Sanofi-Aventis, Janssen-Cilag and GlaxoSmithKline. D Forman - Has received speaker fees from Astra Zeneca P Moayyedi - Chair is partly funded by an unrestricted donation from AstraZeneca to McMaster University. Has been on the speaker's bureau for AstraZeneca, Altana and Janssen-Ortho Has been on the advisory boards of AstraZeneca and Janssen-Ortho C Howden - Previously consulted for TAP Pharmaceutical Products Inc, Takeda Chemical Industries, and Altana Pharma Currently consults for Santarus Inc., Takeda Pharmaceuticals North America, Procter & Gamble, Xenoport Speaker's bureau for Santarus Inc, AstraZeneca and Takeda Pharmaceuticals North America Previous research grant support from AstraZeneca Was previously an investigator and speaker for Merck. EDAT- 2010/07/09 06:00 MHDA- 2010/08/12 06:00 PMCR- 2011/07/07 CRDT- 2010/07/09 06:00 PHST- 2010/07/09 06:00 [entrez] PHST- 2010/07/09 06:00 [pubmed] PHST- 2010/08/12 06:00 [medline] PHST- 2011/07/07 00:00 [pmc-release] AID - CD005415.pub3 [pii] AID - 10.1002/14651858.CD005415.pub3 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2010 Jul 7;2010(7):CD005415. doi: 10.1002/14651858.CD005415.pub3.