Professor Howden and colleagues undertook a systematic review and meta-analysis.
The researchers’ objective was to review randomised controlled trials of treatment with a proton pump inhibitor in patients with ulcer bleeding and determine the impact on mortality, rebleeding, and surgical intervention.
The investigators consulted data sources that included the Cochrane Collaboration's trials register, Medline, and Embase, and also handsearched abstracts and pharmaceutical companies.
The research team included randomised controlled trials that compared proton pump inhibitor with placebo or H2 receptor antagonist in endoscopically proved bleeding ulcer and reported at least one of mortality, rebleeding, or surgical intervention.
Trials were graded for methodological quality.
| The researchers included 21 randomised controlled trials comprising 2915 patients
|British Medical Journal|
Each trial was reviewed independently by 2 assessors, and disagreements were resolved by consensus.
The researchers included 21 randomised controlled trials comprising 2915 patients.
Proton pump inhibitor treatment had no significant effect on mortality (odds ratio 1) but reduced rebleeding (odds ratio 0.5) and surgery (odds ratio 0.6).
The investigators reported similar results when the meta-analysis was restricted to the 10 trials with the highest methodological quality.
The results of the restricted meta-analysis showed odds ratios for mortality, rebleeding, and surgery to be 0.96, 0.4 and 0.6 respectively.
Professor Howden concluded, “Treatment with a proton pump inhibitor reduces the risk of rebleeding and the requirement for surgery after ulcer bleeding but has no benefit on overall mortality.”