 |
|
LESS IS MORE
High-Dose vs Non–High-Dose Proton Pump Inhibitors After Endoscopic Treatment in Patients With Bleeding Peptic UlcerA Systematic Review and Meta-analysis of Randomized Controlled Trials
Chih-Hung Wang, MD;
Matthew Huei-Ming Ma, MD, PhD;
Hao-Chang Chou, MD;
Zui-Shen Yen, MD, MPH;
Chih-Wei Yang, MD;
Cheng-Chung Fang, MD;
Shyr-Chyr Chen, MD
Arch Intern Med. 2010;170(9):751-758.
Background High-dose proton pump inhibitors (PPIs) (80-mg bolus, followed by 8-mg/h continuous infusion for 72 hours) have been widely studied and used. However, to date no concrete evidence has shown that high-dose PPIs are more effective than non–high-dose PPIs.
Methods We performed a literature search for randomized controlled trials that compared the use of high-dose PPIs vs non–high-dose PPIs in patients with bleeding peptic ulcer and determined their effects on rebleeding, surgical intervention, and mortality. Outcomes data were combined in a meta-analysis and were reported as odds ratios (ORs) with 95% confidence intervals (CIs).
Results A total of 1157 patients from 7 high-quality randomized studies were included in this meta-analysis. High-dose PPIs and non–high-dose PPIs did not differ in their effects on the rates of rebleeding (7 studies and 1157 patients; OR, 1.30; 95% CI, 0.88-1.91), surgical intervention (6 studies and 1052 patients; 1.49; 0.66-3.37), or mortality (6 studies and 1052 patients; 0.89; 0.37-2.13). Post hoc subgroup analyses revealed that summary outcomes measures were unaffected by severity of signs of recent hemorrhage at initial endoscopy, route of PPI administration, or PPI dose.
Conclusion Compared with non–high-dose PPIs, high-dose PPIs do not further reduce the rates of rebleeding, surgical intervention, or mortality after endoscopic treatment in patients with bleeding peptic ulcer.
Author Affiliations: Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.
 CiteULike  Connotea  Delicious  Digg  Facebook  Reddit  Technorati  Twitter
What's this?
RELATED LETTERS
Proton Pump Inhibitor Dose for Ulcer Bleeding: Is Less Really More?
Grigoris I. Leontiadis and Colin W. Howden
Arch Intern Med. 2010;170(18):1697-1698.
EXTRACT
| FULL TEXT
High-Dose PPIs in Patients With Variceal Hemorrhage
Cesar Alaniz, Rima A. Mohammad, and Lynda S. Welage
Arch Intern Med. 2010;170(18):1698.
EXTRACT
| FULL TEXT
High-Dose vs Non–High-Dose PPIs After Endoscopic Treatment in Patients With Bleeding Peptic Ulcer: Current Evidence Is Insufficient to Claim Equivalence
Xavier Calvet, Alan Barkun, Marc Bardou, Joseph Sung, and Ernst J. Kuipers
Arch Intern Med. 2010;170(18):1698-1699.
EXTRACT
| FULL TEXT
High or Low Doses of PPIs for Patients With Peptic Ulcer Bleeding?
Hwai-Jen Lin
Arch Intern Med. 2010;170(18):1699-1700.
EXTRACT
| FULL TEXT
High or Low Doses of PPIs for Patients With Peptic Ulcer Bleeding?—Reply
Chihhung Wang, Matthew Huei-Ming Ma, Cheng-Chung Fang, Shyr-Chyr Chen, and Zui-Shen Yen
Arch Intern Med. 2010;170(18):1700.
EXTRACT
| FULL TEXT
RELATED ARTICLES
Failing the Acid Test: Benefits of Proton Pump Inhibitors May Not Justify the Risks for Many Users
Mitchell H. Katz
Arch Intern Med. 2010;170(9):747-748.
EXTRACT
| FULL TEXT
Less Is More: How Less Health Care Can Result in Better Health
Deborah Grady and Rita F. Redberg
Arch Intern Med. 2010;170(9):749-750.
EXTRACT
| FULL TEXT
Proton Pump Inhibitor Use, Hip Fracture, and Change in Bone Mineral Density in Postmenopausal Women: Results From the Women's Health Initiative
Shelly L. Gray, Andrea Z. LaCroix, Joseph Larson, John Robbins, Jane A. Cauley, JoAnn E. Manson, and Zhao Chen
Arch Intern Med. 2010;170(9):765-771.
ABSTRACT
| FULL TEXT
Proton Pump Inhibitors and Risk for Recurrent Clostridium difficile Infection
Amy Linsky, Kalpana Gupta, Elizabeth V. Lawler, Jennifer R. Fonda, and John A. Hermos
Arch Intern Med. 2010;170(9):772-778.
ABSTRACT
| FULL TEXT
Proton Pump Inhibitors for Prophylaxis of Nosocomial Upper Gastrointestinal Tract Bleeding: Effect of Standardized Guidelines on Prescribing Practice
Patrick S. Yachimski, Elizabeth A. Farrell, Daniel P. Hunt, and Andrea E. Reid
Arch Intern Med. 2010;170(9):779-783.
ABSTRACT
| FULL TEXT
Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection
Michael D. Howell, Victor Novack, Philip Grgurich, Diane Soulliard, Lena Novack, Michael Pencina, and Daniel Talmor
Arch Intern Med. 2010;170(9):784-790.
ABSTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding
Sung et al.
Gut 2011;60:1170-1177.
ABSTRACT
| FULL TEXT
Single-Center Trials Show Larger Treatment Effects Than Multicenter Trials: Evidence From a Meta-epidemiologic Study
Dechartres et al.
ANN INTERN MED 2011;155:39-51.
ABSTRACT
| FULL TEXT
Proton Pump Inhibitor Dose for Ulcer Bleeding: Is Less Really More?
Leontiadis and Howden
Arch Intern Med 2010;170:1697-1698.
FULL TEXT
High-Dose PPIs in Patients With Variceal Hemorrhage
Alaniz et al.
Arch Intern Med 2010;170:1698-1698.
FULL TEXT
High or Low Doses of PPIs for Patients With Peptic Ulcer Bleeding?
Lin
Arch Intern Med 2010;170:1699-1700.
FULL TEXT
High or Low Doses of PPIs for Patients With Peptic Ulcer Bleeding?--Reply
Wang et al.
Arch Intern Med 2010;170:1700-1700.
FULL TEXT
High-Dose vs Non-High-Dose PPIs After Endoscopic Treatment in Patients With Bleeding Peptic Ulcer: Current Evidence Is Insufficient to Claim Equivalence
Calvet et al.
Arch Intern Med 2010;170:1698-1699.
FULL TEXT
Proton-Pump Inhibitor Dosing and Negative Consequences
JWatch General 2010;2010:2-2.
FULL TEXT
High-Dose vs. Low-Dose Proton-Pump Inhibitors
JWatch Gastroenterology 2010;2010:1-1.
FULL TEXT
Failing the Acid Test: Benefits of Proton Pump Inhibitors May Not Justify the Risks for Many Users
Katz
Arch Intern Med 2010;170:747-748.
FULL TEXT
|
