High-dose vs low-dose proton pump inhibitors for upper gastrointestinal bleeding: a meta-analysis.
OBJECTIVE
To evaluate the efficacy of high-dose proton pump inhibitors (PPIs) vs low-dose PPIs for patients with upper gastrointestinal bleeding.


METHODS
PubMed, Embase, the Cochrane Library, and Web of Science were searched to identify relevant randomized controlled trials (RCTs). Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis. The primary endpoint was rebleeding; secondary endpoints were patient numbers that needed surgery, and mortality. The meta-analysis was performed with a fixed effects model or random effects model.


RESULTS
Nine eligible RCTs including 1342 patients were retrieved. The results showed that high-dose intravenous PPI was not superior to low-dose intravenous PPI in reducing rebleeding [odds ratio (OR) = 1.091, 95% confidential interval (CI): 0.777-1.532], need for surgery (OR = 1.522, 95% CI: 0.643-3.605) and mortality (OR = 1.022, 95% CI: 0.476-2.196). Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients (OR = 0.831, 95% CI, 0.467-1.480) and European patients (OR = 1.263, 95% CI: 0.827-1.929).


CONCLUSIONS
Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.
Wu
Liu-Cheng
LC
Department of Colorectal and Anal Surgery, First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Cao
Yun-Fei
YF
Huang
Jia-Hao
JH
Liao
Cun
C
Gao
Feng
F
D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control / Q000601:surgery; D016558:Hemostasis, Endoscopic; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D041742:Upper Gastrointestinal Tract / Q000473:pathology* / Q000601:surgery
D054328:Proton Pump Inhibitors