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Meta-analysis: proton-pump inhibition in high-risk patients with acute peptic ulcer bleeding

  1. M. Bardou1,2,
  2. Y. Toubouti3,
  3. D. Benhaberou-Brun1,
  4. E. Rahme3,
  5. A. N. Barkun1,3

Article first published online: 17 MAR 2005

DOI: 10.1111/j.1365-2036.2005.02391.x

Issue

Alimentary Pharmacology & Therapeutics

Alimentary Pharmacology & Therapeutics

Volume 21, Issue 6, pages 677–686, March 2005

Additional Information

How to Cite

Bardou, M., Toubouti, Y., Benhaberou-Brun, D., Rahme, E. and Barkun, A. N. (2005), Meta-analysis: proton-pump inhibition in high-risk patients with acute peptic ulcer bleeding. Alimentary Pharmacology & Therapeutics, 21: 677–686. doi: 10.1111/j.1365-2036.2005.02391.x

Author Information

  1. 1

    Division of Gastroenterology, the McGill University Health Centre, Montreal General Hospital Site, Montréal, Québec, Canada

  2. 2

    Division of Clinical Pharmacology, LPPCE, Faculty of Medicine, Dijon Cedex, France

  3. 3

    Division of Clinical Epidemiology, the McGill University Health Centre, Montreal General Hospital Site, Montréal, Québec, Canada

*Dr M. Bardou, Division of Gastroenterology, The McGill University Health Centre, Montreal General Hospital Site, Room D7-148, 1650, Cedar Avenue, Montréal, Québec H3G 1A4, Canada. E-mail: marc.bardou@u-bourgogne.fr

Publication History

  1. Issue published online: 17 MAR 2005
  2. Article first published online: 17 MAR 2005
  3. Accepted for publication 22 December 2004

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Summary

Background:  Recent data suggest that profound acid suppression may improve outcomes of patients in peptic ulcer bleeding.

Aim:  To better characterize the role of different pharmacological therapies in this population.

Methods:  MEDLINE was used to identify randomized trials (01/1990–04/2003) that assessed the efficacy of pharmacological treatments for patients with bleeding peptic ulcers exhibiting high-risk stigmata (Forrest Ia–IIb). Three groups of treatment were assessed: proton-pump inhibitors given as high-dose bolus followed by intravenous constant infusion (40–80 mg and at least 6 mg/h), high-dose oral proton-pump inhibitors (at least twice the standard dosage), non-high-dose proton-pump inhibitors (other proton-pump inhibitors dosing schedules). Mixed-effect models were used to determine rate differences between treatment and control groups.

Results:  Eighteen studies (1855 patients) were included. High-dose intravenous proton-pump inhibitors significantly reduced rebleeding (−14.6%), surgery (−5.4%) and mortality (−2.7%) compared with placebo, and rebleeding (−20.6%) compared with H2RA. Compared with placebo, high-dose oral proton-pump inhibitors significantly reduced only rebleeding (−11.8%), while non-high-dose proton-pump inhibitor treatment significantly improved all three outcomes.

Conclusions:  High-dose intravenous proton-pump inhibitor significantly decreases ulcer rebleeding, surgery and mortality. Early data on high-dose oral proton-pump inhibitor suggest improved rebleeding. The non-high-dose proton-pump inhibitor regimens, including a broad range of dosing, also improved outcomes, suggesting that doses inferior to those in the high-dose intravenous proton-pump inhibitor may be effective.

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