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Comparing intravenous and oral proton pump inhibitor therapy for bleeding peptic ulcers following endoscopic management: a systematic review and meta‐analysis
Author(s) -
Tringali Alberto,
Manta Raffaele,
Sica Mariano,
Bassotti Gabrio,
Marmo Riccardo,
Mutignani Massimiliano
Publication year - 2017
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.13258
Subject(s) - medicine , odds ratio , peptic , proton pump inhibitor , cochrane library , randomized controlled trial , confidence interval , meta analysis , blood transfusion , endoscopy , therapeutic endoscopy , surgery , peptic ulcer
Background and Aims The efficacy of proton pump inhibitors (PPIs) has been demonstrated for bleeding peptic ulcers but the route of administration remains controversial. Several studies have demonstrated that high‐dose oral PPIs are as effective as intravenous PPIs in reducing recurrent bleeding. However, current guidelines recommend intravenous PPIs after endoscopic treatment. Previous data based on numbers that were too small to enable a firm conclusion to be reached suggested that oral and intravenous PPIs had equivalent efficacy. We undertook a meta‐analysis to compare oral and intravenous PPIs in patients with bleeding peptic ulcers after endoscopic management. Methods A literature search was undertaken using MEDLINE, EMBASE and the Cochrane Library, between 1990 and February 2016, to identify all randomized controlled trials (RCTs) that assessed the efficacy of PPIs administered by different routes. Nine RCTs, involving 1036 patients, were analysed. Outcomes were: recurrent bleeding, blood transfusion requirement, duration of hospital stay, a need for repeat endoscopy, surgery and 30‐day mortality. Results There were no differences in the rebleeding rates [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.60, 1.46; P = 0.77], need for surgery (OR 0.77, 95% CI 0.25, 2.40; P = 0.65), need for repeat endoscopy (OR 0.69, 95% CI 0.39, 1.21; P = 0.19), need for blood transfusion [(MD) –0.03, 95% CI –0.26, 0.19; P = 0.76], duration of hospital stay (MD –0.61, 95% CI –1.45, 0.23; P = 0.16) or 30‐day mortality (OR 0.89, 95% CI 0.27, 2.43; P = 0.84) according to the route of administration. Conclusions Oral PPIs represent better value for money, with clinical efficacy equivalent to intravenous PPIs.