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Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding

Grigoris I Leontiadis1, Virender K Sharma, Colin W Howden

  • 1Department of Gastroenterology, University Hospital of North Durham, Durham DH1 5TW.

BMJ (Clinical Research Ed.)
|February 3, 2005
PubMed

Insights

Proton pump inhibitors significantly reduce rebleeding and surgery rates in patients with ulcer bleeding. However, this study found no significant impact on overall mortality for these patients.

Area of Science:

  • Gastroenterology
  • Clinical Medicine
  • Pharmacology

Background:

  • Peptic ulcer bleeding is a significant cause of morbidity and mortality.
  • Proton pump inhibitors (PPIs) are widely used for acid suppression.
  • The efficacy of PPIs in managing bleeding ulcers requires clear definition.

Purpose of the Study:

  • To systematically review randomized controlled trials (RCTs) on PPI treatment for ulcer bleeding.
  • To evaluate the impact of PPIs on mortality, rebleeding, and surgical intervention.
  • To assess the effect of PPIs based on study quality.

Main Methods:

  • Systematic review and meta-analysis of 21 RCTs involving 2915 patients.
  • Included trials compared PPIs with placebo or H2 receptor antagonists.
  • Trials were assessed for methodological quality; data were analyzed independently.

Main Results:

  • PPI treatment did not significantly affect mortality (OR 1.11, 95% CI 0.79-1.57).
  • PPIs significantly reduced rebleeding (OR 0.46, 95% CI 0.33-0.64; NNT 12).
  • PPIs also reduced the need for surgery (OR 0.59, 95% CI 0.46-0.76; NNT 20).

Conclusions:

  • Proton pump inhibitors are effective in reducing rebleeding and surgical intervention in patients with ulcer bleeding.
  • PPIs do not demonstrate a significant benefit in reducing overall mortality for this patient group.
  • The findings were consistent even when analyzing high-quality trials.
Abstract

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