Systematic review and meta-analysis: enhanced efficacy of proton-pump inhibitor therapy for peptic ulcer bleeding in Asia – a post hoc analysis from the Cochrane Collaboration


Dr C. W. Howden, Division of Gastroenterology, Northwestern University, Feinberg School of Medicine, 676 N. St Clair Street, Suite 1400, Chicago, IL 60611, USA.


Background : Proton-pump inhibitors reduce re-bleeding rates after ulcer bleeding. However, there is significant heterogeneity among different randomized-controlled trials.

Aim : To see whether proton-pump inhibitors for ulcer bleeding produced different clinical outcomes in different geographical locations.

Methods : This was a post hoc analysis of our Cochrane Collaboration systematic review and meta-analysis of proton-pump inhibitor therapy for ulcer bleeding. Sixteen randomized-controlled trials conducted in Europe and North America were pooled and re-analysed separately from seven conducted in Asia. We calculated pooled rates for 30-day all-cause mortality, re-bleeding and surgical intervention and derived odds ratios and numbers needed to treat with 95% confidence intervals.

Results : There was no significant heterogeneity for any outcome. Reduced all-cause mortality was seen in the Asian randomized-controlled trials (odds ratios = 0.35; 95% confidence interval: 0.16–0.74; number needed to treat = 33), but not in the others (odds ratios = 1.36; 95% confidence interval: 0.94–1.96; number needed to treat – incalculable). There were significant reductions in re-bleeding and surgery in both sets of randomized-controlled trials, but the effects were quantitatively greater in Asia.

Conclusions : Proton-pump inhibitor therapy for ulcer bleeding has been more efficacious in Asia than elsewhere. This may be because of an enhanced pharmacodynamic effect of proton-pump inhibitors in Asian patients.