PPI treatment beneficial to patients with ulcer bleeding, according to meta-analysis

Key Points

When used to treat patients with ulcer bleeding, proton-pump inhibitors (PPIs) effectively reduce the risk of rebleeding and the need for surgical intervention and repeated endoscopic treatment, according to a meta-analysis published in the journal Mayo Clinic Proceedings.

This study was the result of a database search of MEDLINE, EMBASE, CENTRAL, the Cochrane Library, and metaRegister of Controlled Trials databases and published proceedings from clinical conferences through November 2004. Researchers selected randomized, controlled trials on peptic ulcer bleeding that compared oral or intravenous PPIs with placebo or a histamine₂-receptor antagonist. Measured outcomes included 30-day all-cause mortality, rebleeding, surgical intervention, and ongoing endoscopic treatment.

The primary outcome was mortality from any cause within 30 days of randomizing. Rebleeding, surgery, and further endoscopic treatment within 30 days of randomization were all secondary end points. Upon extracting the most relevant studies from an initial pool of 181 articles, investigators analyzed 24 trials (4,373 participants).

In subgroup analysis, PPI therapy markedly reduced the risk of mortality in trials conducted in Asian countries (OR=0.35; 95% CI, 0.16–0.74). PPI use was also associated with a lower mortality rate in patients with active bleeding or a nonbleeding visible vessel (OR=0.53; 95% CI, 0.31–0.91); the significance remained only when the analysis was limited to the consistent use of initial endoscopic hemostatic treatment (OR=0.54; 95% CI, 0.30–0.96 vs OR=0.51; 95% CI, 0.12–2.12 for trials with inconsistent use of initial endoscopic hemostatic treatment).

The authors stated that, based on these results: "PPI treatment should be initiated as soon as practicable in patients with ulcer bleeding." They stated that the route of PPI delivery should be determined by physicians, who should take into account the presence of major endoscopic stigmas (ie, active bleeding).

SOURCE

Leontiadis GI, Sharma VK, Howden CW. Proton pump inhibitor therapy for peptic ulcer bleeding: Cochrane collaboration meta-analysis of randomized controlled trials. Mayo Clin Proc. 2007;82:286–296.