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Oral vs intravenous PPI in patients with peptic ulcer bleeding

This month's Alimentary Pharmacology & Therapeutics compares oral with intravenous proton pump inhibitors in patients with peptic ulcer bleeding.

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The efficacy of adjuvant use of intravenous proton pump inhibitors after endoscopic therapy has been proved in peptic ulcer bleeding patients, but the efficacy of oral PPIs is uncertain.

Dr Tsoi and colleagues from Hong Kong compared the clinical outcomes of oral proton pump inhibitors vs. intravenous proton pump inhibitors in patients with peptic ulcer bleeding.

The team analyzed prospective randomised controlled trials that were systematically searched from OVID databases until 2012.

Trials comparing oral and intravenous proton pump inhibitors among patients with peptic ulcer bleeding were included.

Recurrent bleeding, length of hospitalization, blood transfusion, requirement of surgery and mortality were measured.

The risk of bias, study quality and heterogeneity were also evaluated.

The calculated pooled gastric cancer incidence-rate was about 0.3% per person-years
Alimentary Pharmacology & Therapeutics

The doctors also identified 6 randomized trials from 2006 to 2011.

The researchers noted that a total of 615 patients were randomly assigned to receive oral proton pump inhibitors or intravenous proton pump inhibitors.

The mean age was 60 years and 71% was male.

No significant difference between oral and intravenous proton pump inhibitors was observed regarding recurrent bleeding, mean volume of blood transfused, requirement of surgery and all-cause mortality.

The research team observed that the duration of hospital stay in days was significantly shortened in those using oral proton pump inhibitors.

Dr Tsoi's team commented, "Oral proton pump inhibitors demonstrate a similar effectiveness to intravenous proton pump inhibitors among patients with peptic ulcer bleeding, but the results were combined from open-labelled trials with limited sample size."

"A large double-blind non-inferiority trial is required to better assess the role of oral proton pump inhibitors."

Aliment Pharmacol & Ther 2013: :38 335-339
26 August 2013

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