Systematic Review and Meta-Analysis: PPIs for Ulcer Bleeding
Systematic Review and Meta-Analysis: PPIs for Ulcer Bleeding
Background: Proton-pump inhibitors reduce re-bleeding and surgical intervention, but not mortality, after ulcer bleeding.
Aim: To examine the effects of proton-pump inhibitor treatment on transfusion requirements and length of hospital stay in patients with ulcer bleeding.
Methods: For the Cochrane Collaboration meta-analysis of randomized-controlled trials of proton-pump inhibitor therapy for ulcer bleeding, outcomes of transfusion requirements and hospital stay were summarized, respectively, as mean (±s.d.) units transfused and hospital days. We calculated weighted mean difference with 95% confidence interval. We also performed subgroup analyses according to geographical origin of the randomized-controlled trials.
Results: There was significant heterogeneity among randomized-controlled trials for either outcome. Overall, proton-pump inhibitor treatment marginally reduced transfusion requirements (WMD = -0.6 units; 95% CI: -1.1 to 0; P = 0.05) and length of hospitalization (WMD = -1.1 days; 95% CI: -1.5 to -0.7; P < 0.0001). Most of the randomized-controlled trials did not state precise criteria for administering blood transfusion and discharging patients, thereby limiting the strength of conclusions on the pooled effects.
Conclusions: Proton-pump inhibitor treatment for ulcer bleeding produces small, but potentially important, reductions in transfusion requirements and length of hospitalization.
Peptic ulcer is the most frequent cause of acute upper gastrointestinal tract bleeding resulting in hospitalization. There is a substantive clinical and economic burden associated with the management of patients with ulcer bleeding. Proton-pump inhibitors (PPIs) are frequently used as part of initial management. The Cochrane Collaboration systematic review and meta-analysis of randomized-controlled trials (RCTs) of PPI treatment for ulcer bleeding found no significant effect on 30-day all-cause mortality, which was the predetermined primary end-point. PPI treatment did significantly reduce rates of ulcer re-bleeding and surgical intervention, which were predefined secondary end-points. Some RCTs also provided information on other clinically relevant end-points including blood transfusion requirements and length of hospital stay. Analyses of those end-points were not included in our original publication, and are now reported here.
Background: Proton-pump inhibitors reduce re-bleeding and surgical intervention, but not mortality, after ulcer bleeding.
Aim: To examine the effects of proton-pump inhibitor treatment on transfusion requirements and length of hospital stay in patients with ulcer bleeding.
Methods: For the Cochrane Collaboration meta-analysis of randomized-controlled trials of proton-pump inhibitor therapy for ulcer bleeding, outcomes of transfusion requirements and hospital stay were summarized, respectively, as mean (±s.d.) units transfused and hospital days. We calculated weighted mean difference with 95% confidence interval. We also performed subgroup analyses according to geographical origin of the randomized-controlled trials.
Results: There was significant heterogeneity among randomized-controlled trials for either outcome. Overall, proton-pump inhibitor treatment marginally reduced transfusion requirements (WMD = -0.6 units; 95% CI: -1.1 to 0; P = 0.05) and length of hospitalization (WMD = -1.1 days; 95% CI: -1.5 to -0.7; P < 0.0001). Most of the randomized-controlled trials did not state precise criteria for administering blood transfusion and discharging patients, thereby limiting the strength of conclusions on the pooled effects.
Conclusions: Proton-pump inhibitor treatment for ulcer bleeding produces small, but potentially important, reductions in transfusion requirements and length of hospitalization.
Peptic ulcer is the most frequent cause of acute upper gastrointestinal tract bleeding resulting in hospitalization. There is a substantive clinical and economic burden associated with the management of patients with ulcer bleeding. Proton-pump inhibitors (PPIs) are frequently used as part of initial management. The Cochrane Collaboration systematic review and meta-analysis of randomized-controlled trials (RCTs) of PPI treatment for ulcer bleeding found no significant effect on 30-day all-cause mortality, which was the predetermined primary end-point. PPI treatment did significantly reduce rates of ulcer re-bleeding and surgical intervention, which were predefined secondary end-points. Some RCTs also provided information on other clinically relevant end-points including blood transfusion requirements and length of hospital stay. Analyses of those end-points were not included in our original publication, and are now reported here.
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