As part of AP&T's peer-review process, a technical check of this meta-analysis was performed by Dr P. Collins.
Meta-analysis: comparison of oral vs. intravenous proton pump inhibitors in patients with peptic ulcer bleeding
Article first published online: 5 AUG 2013
© 2013 John Wiley & Sons Ltd
Alimentary Pharmacology & Therapeutics
Volume 38, Issue 7, pages 721–728, October 2013
How to Cite
Tsoi, K. K. F., Hirai, H. W. and Sung, J. J. Y. (2013), Meta-analysis: comparison of oral vs. intravenous proton pump inhibitors in patients with peptic ulcer bleeding. Alimentary Pharmacology & Therapeutics, 38: 721–728. doi: 10.1111/apt.12441
- Issue published online: 3 SEP 2013
- Article first published online: 5 AUG 2013
- Manuscript Accepted: 14 JUL 2013
- Manuscript Revised: 20 JUN 2013
- Manuscript Revised: 12 JUN 2013
- Manuscript Received: 16 MAY 2013
The efficacy of adjuvant use of intravenous proton pump inhibitors (PPIs) after endoscopic therapy has been proved in peptic ulcer bleeding patients, but the efficacy of oral PPIs is uncertain.
To compare the clinical outcomes of oral PPIs vs. intravenous PPIs in patients with peptic ulcer bleeding.
Prospective randomised controlled trials were systematically searched from OVID databases until June 2012. Trials comparing oral and intravenous PPIs among patients with peptic ulcer bleeding were included. Recurrent bleeding, length of hospitalisation, blood transfusion, requirement of surgery and mortality were measured. The risk of bias, study quality and heterogeneity were also evaluated.
Six randomised trials from 2006 to 2011 were included. A total of 615 patients were randomly assigned to receive oral PPIs (n = 302) or intravenous PPIs (n = 313). The mean age was 60 years and 71.1% was male. No significant difference between oral and intravenous PPIs was observed regarding recurrent bleeding (RR: 0.92, 95% CI: 0.56–1.50), mean volume of blood transfused (−0.02 unit, 95% CI: −0.29–0.24 unit), requirement of surgery (RR: 0.82, 95% CI: 0.19–3.61) and all-cause mortality (RR: 0.88, 95% CI: 0.29–2.71). The duration of hospital stay in days was significantly shortened in those using oral PPIs (−0.74 day, 95% CI: −1.10 day to −0.39 day).
Oral PPIs demonstrate a similar effectiveness to intravenous PPIs among patients with peptic ulcer bleeding, but the results were combined from open-labelled trials with limited sample size. A large double-blind non-inferiority trial is required to better assess the role of oral PPIs.