Comparing intravenous and oral proton pump inhibitor therapy for bleeding peptic ulcers following endoscopic management: a systematic review and meta-analysis.
The efficacy of proton pump inhibitors (PPIs) has been demonstrated for bleeding peptic ulcers but the route of administration remains controversial. Several studies have demonstrated that high-dose oral PPIs are as effective as intravenous PPIs in reducing recurrent bleeding. However, current guidelines recommend intravenous PPIs after endoscopic treatment. Previous data based on numbers that were too small to enable a firm conclusion to be reached suggested that oral and intravenous PPIs had equivalent efficacy. We undertook a meta-analysis to compare oral and intravenous PPIs in patients with bleeding peptic ulcers after endoscopic management.



A literature search was undertaken using MEDLINE, EMBASE and the Cochrane Library, between 1990 and February 2016, to identify all randomized controlled trials (RCTs) that assessed the efficacy of PPIs administered by different routes. Nine RCTs, involving 1036 patients, were analysed. Outcomes were: recurrent bleeding, blood transfusion requirement, duration of hospital stay, a need for repeat endoscopy, surgery and 30-day mortality.



There were no differences in the rebleeding rates [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.60, 1.46; P = 0.77], need for surgery (OR 0.77, 95% CI 0.25, 2.40; P = 0.65), need for repeat endoscopy (OR 0.69, 95% CI 0.39, 1.21; P = 0.19), need for blood transfusion [(MD) -0.03, 95% CI -0.26, 0.19; P = 0.76], duration of hospital stay (MD -0.61, 95% CI -1.45, 0.23; P = 0.16) or 30-day mortality (OR 0.89, 95% CI 0.27, 2.43; P = 0.84) according to the route of administration.



Oral PPIs represent better value for money, with clinical efficacy equivalent to intravenous PPIs.
Endoscopy Unit, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Alberto
0000-0003-4518-2146
A
Tringali
Endoscopy Unit, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Raffaele
R
Manta
Endoscopy Unit, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Mariano
M
Sica
Gastroenterology & Hepatology Section, Department of Medicine, University of Perugia Medical School, Perugia, Italy.
Gabrio
G
Bassotti
Gastroenterologia ed Endoscopia Digestiva del PO di Polla, Salerno, Italy.
Riccardo
R
Marmo
Endoscopy Unit, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Massimiliano
M
Mutignani
D061605:Administration, Intravenous; D000284:Administration, Oral; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D010437:Peptic Ulcer / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010438:Peptic Ulcer Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors
bleeding peptic ulcers; endoscopic treatment; intravenous PPIs; meta-analysis; oral PPIs; proton pump inhibitors