PMID- 27505402
OWN - NLM
STAT- MEDLINE
DCOM- 20180501
LR  - 20181202
IS  - 1539-2031 (Electronic)
IS  - 0192-0790 (Linking)
VI  - 51
IP  - 8
DP  - 2017 Sep
TI  - Value of Oral Proton Pump Inhibitors in Acute, Nonvariceal Upper Gastrointestinal 
      Bleeding: A Network Meta-Analysis.
PG  - 707-719
LID - 10.1097/MCG.0000000000000625 [doi]
AB  - BACKGROUND: Intravenous (IV) proton pump inhibitors (PPI) are the standard 
      medical treatment in acute nonvariceal upper gastrointestinal bleeding (ANVGIB). 
      Optimal route of PPI delivery has been questioned. AIM: The aim was to perform a 
      systematic review and network meta-analysis for the endpoints of risk of 
      rebleeding, length of stay (LOS), surgery (ROS), mortality, and total units of 
      blood transfused (UBT) among trials evaluating acid suppressive medications in 
      ANVGIB. METHODS: A total of 39 studies using IV PPI drip, IV scheduled PPI, oral 
      PPI, H2-receptor antagonists, and placebo were identified. Network meta-analysis 
      was used for indirect comparisons and Bayesian Markov Chain Monte Carlo methods 
      for calculation of probability superiority. RESULTS: No difference was observed 
      between IV PPI drip and scheduled IV PPI for mortality (relative risk=1.11; 95% 
      credibility interval, 0.56-2.21), LOS (0.04, -0.49 to 0.44), ROS (1.27, 
      0.64-2.35) and risk of rebleeding within 72 hours, 1 week, and 1 month [(0.98, 
      0.48-1.95), (0.59, 0.13-2.03), (0.82, 0.28-2.16)]. Oral PPIs were as effective as 
      IV scheduled PPIs and IV PPI drip for LOS (0.22, -0.61 to 0.79 and 0.16, -0.56 to 
      0.80) and UBT (-0.25, -1.23 to 0.65 and -0.06, -0.71 to 0.65) and superior to IV 
      PPI drip for ROS (0.30, 0.10 to 0.78). CONCLUSION: Scheduled IV PPIs were as 
      effective as IV PPI drip for most outcomes. Oral PPIs were comparable to 
      scheduled IV for LOS and UBT and superior to IV PPI drip for ROS. Conclusions 
      should be tempered by low frequency endpoints such as ROS, but question the need 
      for IV PPI drip in ANVGIB.
FAU - Rodriguez, Eduardo A
AU  - Rodriguez EA
AD  - *Department of Internal Medicine, University of Miami Palm Beach Regional Campus, 
      Atlantis  parallelDepartment of Internal Medicine, Division of Gastroenterology, 
      University of Miami Leonard Miller School of Medicine, Miami, FL daggerVeteran Affairs 
      Center for Clinical Management Research double daggerInstitute for Healthcare Policy and 
      Innovation  section signDepartment of Internal Medicine, Division of Gastroenterology and 
      Hepatology, University of Michigan Medical School, Ann Arbor, MI.
FAU - Donath, Elie
AU  - Donath E
FAU - Waljee, Akbar K
AU  - Waljee AK
FAU - Sussman, Daniel A
AU  - Sussman DA
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - J Clin Gastroenterol
JT  - Journal of clinical gastroenterology
JID - 7910017
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Administration, Oral
MH  - Drug Administration Schedule
MH  - Gastrointestinal Hemorrhage/*drug therapy
MH  - Peptic Ulcer Hemorrhage/*drug therapy
MH  - Proton Pump Inhibitors/administration & dosage/*therapeutic use
MH  - Treatment Outcome
EDAT- 2016/08/10 06:00
MHDA- 2018/05/02 06:00
CRDT- 2016/08/10 06:00
PHST- 2016/08/10 06:00 [pubmed]
PHST- 2018/05/02 06:00 [medline]
PHST- 2016/08/10 06:00 [entrez]
AID - 10.1097/MCG.0000000000000625 [doi]
PST - ppublish
SO  - J Clin Gastroenterol. 2017 Sep;51(8):707-719. doi: 10.1097/MCG.0000000000000625.