PMID- 33988530
OWN - NLM
STAT- MEDLINE
DCOM- 20210909
LR  - 20240407
IS  - 2155-384X (Electronic)
IS  - 2155-384X (Linking)
VI  - 12
IP  - 4
DP  - 2021 Apr 14
TI  - Oral Proton Pump Inhibitors May Be as Effective as Intravenous in Peptic Ulcer 
      Bleeding: A Systematic Review and Meta-analysis.
PG  - e00341
LID - 10.14309/ctg.0000000000000341 [doi]
LID - e00341
AB  - INTRODUCTION: Current guidelines recommend intravenous (IV) proton pump inhibitor 
      (PPI) therapy in peptic ulcer bleeding (PUB). We aimed to compare the efficacy of 
      oral and IV administration of PPIs in PUB. METHODS: We performed a systematic 
      search in 4 databases for randomized controlled trials, which compared the 
      outcomes of oral PPI therapy with IV PPI therapy for PUB. The primary outcomes 
      were 30-day recurrent bleeding and 30-day mortality. Odds ratios (ORs) with 95% 
      confidence intervals (CIs) were calculated for dichotomous outcomes, while 
      weighted mean differences (WMDs) with CI were calculated for continuous outcomes 
      in meta-analysis. The protocol was registered a priori onto PROSPERO 
      (CRD42020155852). RESULTS: A total of 14 randomized controlled trials reported 
      1,951 peptic ulcer patients, 977 and 974 of which were in the control and 
      intervention groups, respectively. There were no statistically significant 
      differences between oral and IV administration regarding 30-day rebleeding rate 
      (OR = 0.96, CI: 0.65-1.44); 30-day mortality (OR = 0.70, CI: 0.35-1.40); length 
      of hospital stay (WMD = -0.25, CI: -0.93 to -0.42); transfusion requirements (WMD 
      = -0.09, CI: -0.07 to 0.24); need for surgery (OR = 0.91, CI: 0.40-2.07); further 
      endoscopic therapy (OR = 1.04, CI: 0.56-1.93); and need for re-endoscopy (OR = 
      0.81, CI: 0.52-1.28). Heterogeneity was negligible in all analysis, except for 
      the analysis on the length of hospitalization (I2 = 82.3%, P = 0.001). 
      DISCUSSION: Recent evidence suggests that the oral administration of PPI is not 
      inferior to the IV PPI treatment in PUB after endoscopic management, but further 
      studies are warranted.
CI  - Copyright (c) 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on 
      behalf of The American College of Gastroenterology.
FAU - Csiki, Endre
AU  - Csiki E
AD  - Institute for Translational Medicine, Medical School, Szentagothai Research 
      Center, University of Pecs, Pecs, Hungary.
AD  - Department of Gastroenterology, Mures County Clinical Hospital, George Emil 
      Palade University of Medicine, Pharmacy, Science and Technology of Targu-Mures, 
      Faculty of Medicine, Targu-Mures, Romania.
FAU - Szabo, Hanna
AU  - Szabo H
AD  - Institute for Translational Medicine, Medical School, Szentagothai Research 
      Center, University of Pecs, Pecs, Hungary.
AD  - George Emil Palade University of Medicine, Pharmacy, Science, and Technology of 
      Targu Mures, Faculty of Medicine, Targu-Mures, Romania.
FAU - Hanak, Lilla
AU  - Hanak L
AD  - Institute for Translational Medicine, Medical School, Szentagothai Research 
      Center, University of Pecs, Pecs, Hungary.
FAU - Szakacs, Zsolt
AU  - Szakacs Z
AD  - Institute for Translational Medicine, Medical School, Szentagothai Research 
      Center, University of Pecs, Pecs, Hungary.
FAU - Kiss, Szabolcs
AU  - Kiss S
AD  - Institute for Translational Medicine, Medical School, Szentagothai Research 
      Center, University of Pecs, Pecs, Hungary.
AD  - Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.
FAU - Vorhendi, Nora
AU  - Vorhendi N
AD  - Institute for Translational Medicine, Medical School, Szentagothai Research 
      Center, University of Pecs, Pecs, Hungary.
FAU - Pecsi, Daniel
AU  - Pecsi D
AD  - Division of Gastroenterology, First Department of Medicine, Medical School, 
      University of Pecs, Pecs, Hungary .
FAU - Hegyi, Eszter
AU  - Hegyi E
AD  - Institute for Translational Medicine, Medical School, Szentagothai Research 
      Center, University of Pecs, Pecs, Hungary.
FAU - Hegyi, Peter
AU  - Hegyi P
AD  - Institute for Translational Medicine, Medical School, Szentagothai Research 
      Center, University of Pecs, Pecs, Hungary.
FAU - Eross, Balint
AU  - Eross B
AD  - Institute for Translational Medicine, Medical School, Szentagothai Research 
      Center, University of Pecs, Pecs, Hungary.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20210414
PL  - United States
TA  - Clin Transl Gastroenterol
JT  - Clinical and translational gastroenterology
JID - 101532142
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Administration, Intravenous
MH  - Administration, Oral
MH  - Blood Transfusion
MH  - Endoscopy, Gastrointestinal
MH  - Equivalence Trials as Topic
MH  - Humans
MH  - Length of Stay
MH  - Peptic Ulcer Hemorrhage/*drug therapy/mortality/surgery
MH  - Proton Pump Inhibitors/*administration & dosage
MH  - Secondary Prevention
MH  - Treatment Outcome
PMC - PMC8049165
COIS- Guarantor of the article: Balint Eross, MD, PhD. Specific author contributions: 
      B.E. and E.C. conceptualized and designed the study in cooperation with H.S., 
      Z.S., and N.V.; B.E., E.C. in cooperation with Z.S. and S.K. constructed the 
      search query and performed the search process; E.C. and H.S. screened the 
      articles for eligibility and performed the data extraction; E.C., B.E., E.H., and 
      D.P. conducted the quality assessment; E.C. and B.E. wrote the article; L.H. 
      performed the statistical analysis; Z.S., S.K., P.H., and D.P. provided valuable 
      feedback after critically reviewing the first drafts of the manuscript. All 
      authors reviewed and approved the final manuscript for publication. Financial 
      support: The project titled "GINOP-2.3.2-15-2016-00048-STAY ALIVE" is co-financed 
      by the European Union (European Regional Development Fund) within the framework 
      of Programme Szechenyi 2020. Human Resources Development Operational Programme 
      Grant, Grant Number: EFOP-3.6.2-16-2017-00006-LIVE LONGER is cofinanced by the 
      European Union (European Regional Development Fund) within the framework of 
      Programme Szechenyi 2020. Potential competing interests: None to report.
EDAT- 2021/05/15 06:00
MHDA- 2021/09/10 06:00
PMCR- 2021/04/14
CRDT- 2021/05/14 12:21
PHST- 2020/07/13 00:00 [received]
PHST- 2021/03/05 00:00 [accepted]
PHST- 2021/05/14 12:21 [entrez]
PHST- 2021/05/15 06:00 [pubmed]
PHST- 2021/09/10 06:00 [medline]
PHST- 2021/04/14 00:00 [pmc-release]
AID - 01720094-202104000-00013 [pii]
AID - CTG-20-0386 [pii]
AID - 10.14309/ctg.0000000000000341 [doi]
PST - epublish
SO  - Clin Transl Gastroenterol. 2021 Apr 14;12(4):e00341. doi: 
      10.14309/ctg.0000000000000341.