Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding.
OBJECTIVE
To review randomised controlled trials of treatment with a proton pump inhibitor in patients with ulcer bleeding and determine the impact on mortality, rebleeding, and surgical intervention.


METHODS
Systematic review and meta-analysis.


METHODS
Cochrane Collaboration's trials register, Medline, and Embase, handsearched abstracts, and pharmaceutical companies.


METHODS
Included randomised controlled trials compared proton pump inhibitor with placebo or H2 receptor antagonist in endoscopically proved bleeding ulcer and reported at least one of mortality, rebleeding, or surgical intervention. Trials were graded for methodological quality. Two assessors independently reviewed each trial, and disagreements were resolved by consensus.


RESULTS
We included 21 randomised controlled trials comprising 2915 patients. Proton pump inhibitor treatment had no significant effect on mortality (odds ratio 1.11, 95% confidence interval 0.79 to 1.57; number needed to treat (NNT) incalculable) but reduced rebleeding (0.46, 0.33 to 0.64; NNT 12) and surgery (0.59, 0.46 to 0.76; NNT 20). Results were similar when the meta-analysis was restricted to the 10 trials with the highest methodological quality: 0.96, 0.46 to 2.01, for mortality; 0.41, 0.25 to 0.68, NNT 10, for rebleeding; 0.62, 0.46 to 0.83, NNT 25, for surgery.


CONCLUSIONS
Treatment with a proton pump inhibitor reduces the risk of rebleeding and the requirement for surgery after ulcer bleeding but has no benefit on overall mortality.
Leontiadis
Grigoris I
GI
Department of Gastroenterology, University Hospital of North Durham, Durham DH1 5TW.
Sharma
Virender K
VK
Howden
Colin W
CW
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D006801:Humans; D016017:Odds Ratio; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000601:surgery; D054328:Proton Pump Inhibitors; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors