title: Value of Oral Proton Pump Inhibitors in Acute, Nonvariceal Upper Gastrointestinal Bleeding: A Network Meta-Analysis.
abstract: BACKGROUND
  Intravenous (IV) proton pump inhibitors (PPI) are the standard medical treatment in acute nonvariceal upper gastrointestinal bleeding (ANVGIB). Optimal route of PPI delivery has been questioned.
  
  
  OBJECTIVE
  The aim was to perform a systematic review and network meta-analysis for the endpoints of risk of rebleeding, length of stay (LOS), surgery (ROS), mortality, and total units of blood transfused (UBT) among trials evaluating acid suppressive medications in ANVGIB.
  
  
  METHODS
  A total of 39 studies using IV PPI drip, IV scheduled PPI, oral PPI, H2-receptor antagonists, and placebo were identified. Network meta-analysis was used for indirect comparisons and Bayesian Markov Chain Monte Carlo methods for calculation of probability superiority.
  
  
  RESULTS
  No difference was observed between IV PPI drip and scheduled IV PPI for mortality (relative risk=1.11; 95% credibility interval, 0.56-2.21), LOS (0.04, -0.49 to 0.44), ROS (1.27, 0.64-2.35) and risk of rebleeding within 72 hours, 1 week, and 1 month [(0.98, 0.48-1.95), (0.59, 0.13-2.03), (0.82, 0.28-2.16)]. Oral PPIs were as effective as IV scheduled PPIs and IV PPI drip for LOS (0.22, -0.61 to 0.79 and 0.16, -0.56 to 0.80) and UBT (-0.25, -1.23 to 0.65 and -0.06, -0.71 to 0.65) and superior to IV PPI drip for ROS (0.30, 0.10 to 0.78).
  
  
  CONCLUSIONS
  Scheduled IV PPIs were as effective as IV PPI drip for most outcomes. Oral PPIs were comparable to scheduled IV for LOS and UBT and superior to IV PPI drip for ROS. Conclusions should be tempered by low frequency endpoints such as ROS, but question the need for IV PPI drip in ANVGIB.
authors: *Department of Internal Medicine, University of Miami Palm Beach Regional Campus, Atlantis ∥Department of Internal Medicine, Division of Gastroenterology, University of Miami Leonard Miller School of Medicine, Miami, FL †Veteran Affairs Center for Clinical Management Research ‡Institute for Healthcare Policy and Innovation §Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Medical School, Ann Arbor, MI.
authors: Eduardo A
authors: EA
authors: Rodriguez
authors: Elie
authors: E
authors: Donath
authors: Akbar K
authors: AK
authors: Waljee
authors: Daniel A
authors: DA
authors: Sussman
mesh_terms: D000284:Administration, Oral; D004334:Drug Administration Schedule; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors