Comparing intravenous and oral proton pump inhibitor therapy for bleeding peptic ulcers following endoscopic management. A systematic review and meta-analysis.Tringali A, Manta R, Sica M, Bassotti G, Marmo R, Mutignani M. Br J Clin Pharmacol. 2017 Feb 9. doi: 10.1111/bcp.13258. [Epub ahead of print]
BACKGROUND AND AIMS:The efficacy of proton pump inhibitors (PPI) has been demonstrated for bleeding peptic ulcers but the route of administration remains controversial. Several studies demonstrated that high dose oral PPI are as effective as intravenous PPI in reducing recurrent bleeding. However, current guidelines recommend intravenous PPI after endoscopic treatment.
Previous data based on inadequate numbers to reach a firm conclusion suggested that oral and intravenous PPI had equivalent efficacy. We undertook meta-analysis to compare oral and intravenous PPI in patients with bleeding peptic ulcers after endoscopic management.METHODS:A literature search was undertaken using MEDLINE, EMBASE, Cochrane Library covering 1990 to February 2016 to identify all RCTs that assessed the efficacy of PPI 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.RESULTS:There were no differences in the re-bleeding rates (OR 0.93 95% 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.CONCLUSION:Oral PPI represent better value for money with clinical efficacy equivalent to intravenous PPI.