title: Proton pump inhibitors therapy vs H2 receptor antagonists therapy for upper gastrointestinal bleeding after endoscopy: A meta-analysis.
abstract: OBJECTIVE
  To compare the therapeutic effects of proton pump inhibitors vs H₂ receptor antagonists for upper gastrointestinal bleeding in patients after successful endoscopy.
  
  
  METHODS
  We searched the Cochrane library, MEDLINE, EMBASE and PubMed for randomized controlled trials until July 2014 for this study. The risk of bias was evaluated by the Cochrane Collaboration's tool and all of the studies had acceptable quality. The main outcomes included mortality, re-bleeding, received surgery rate, blood transfusion units and hospital stay time. These outcomes were estimated using odds ratios (OR) and mean difference with 95% confidence interval (CI). RevMan 5.3.3 software and Stata 12.0 software were used for data analyses.
  
  
  RESULTS
  Ten randomized controlled trials involving 1283 patients were included in this review; 678 subjects were in the proton pump inhibitors (PPI) group and the remaining 605 subjects were in the H₂ receptor antagonists (H₂RA) group. The meta-analysis results revealed that after successful endoscopic therapy, compared with H₂RA, PPI therapy had statistically significantly decreased the recurrent bleeding rate (OR = 0.36; 95%CI: 0.25-0.51) and receiving surgery rate (OR = 0.29; 95%CI: 0.09-0.96). There were no statistically significant differences in mortality (OR = 0.46; 95%CI: 0.17-1.23). However, significant heterogeneity was present in both the numbers of patients requiring blood transfusion after treatment [weighted mean difference (WMD), -0.70 unit; 95%CI: -1.64 - 0.25] and the time that patients remained hospitalized [WMD, -0.77 d; 95%CI: -1.87 - 0.34]. The Begg's test (P = 0.283) and Egger's test (P = 0.339) demonstrated that there was no publication bias in our meta-analysis.
  
  
  CONCLUSIONS
  In patients with upper gastrointestinal bleeding after successful endoscopic therapy, compared with H₂RA, PPI may be a more effective therapy.
authors.affiliation: Ying-Shi Zhang, Qing Li, Bo-Sai He, Ran Liu, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China.
authors.forename: Ying-Shi
authors.initials: YS
authors.lastname: Zhang
authors.affiliation: Ying-Shi Zhang, Qing Li, Bo-Sai He, Ran Liu, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Li
authors.affiliation: Ying-Shi Zhang, Qing Li, Bo-Sai He, Ran Liu, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China.
authors.forename: Bo-Sai
authors.initials: BS
authors.lastname: He
authors.affiliation: Ying-Shi Zhang, Qing Li, Bo-Sai He, Ran Liu, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China.
authors.forename: Ran
authors.initials: R
authors.lastname: Liu
authors.affiliation: Ying-Shi Zhang, Qing Li, Bo-Sai He, Ran Liu, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China.
authors.forename: Zuo-Jing
authors.initials: ZJ
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006635:Histamine H2 Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: H2 receptor antagonist; Meta-analysis; Proton pump inhibitor; Randomized controlled trial; Upper gastrointestinal bleeding