Recent data suggest that profound acid suppression may improve outcomes of patients in peptic ulcer bleeding.
Dr Bardou and colleagues characterized the role of different pharmacological therapies in this population.
The researchers searched MEDLINE from January 1990 to April 2003 to identify randomized trials that assessed the efficacy of pharmacological treatments for patients with bleeding peptic ulcers exhibiting high-risk stigmata.
The research team assessed 3 groups of treatment including proton-pump inhibitors (PPIs) given as high-dose bolus followed by intravenous constant infusion (4080 mg and at least 6 mg/h).
The other 2 treatment groups included high-dose oral PPIs(at least twice the standard dosage), and non-high-dose PPIs (other PPI dosing schedules).
|Non-high-dose PPI regimens, including a broad range of dosing, also improved outcomes|
| Alimentary Pharmacology & Therapeutics|
Mixed-effect models were used by the investigative team to determine rate differences between treatment and control groups.
The investigators included 18 studies with 1855 patients.
The team found that high-dose intravenous PPIs significantly reduced rebleeding (15%), surgery (5%) and mortality (3%) compared with placebo, and rebleeding (21%) compared with H2-receptor antagonists.
The researchers also noted that, compared with placebo, high-dose oral PPIs significantly reduced only rebleeding (12%), while non-high-dose PPIs treatment significantly improved all 3 outcomes.
Dr Bardou's team concluded, “High-dose intravenous PPI significantly decreases ulcer rebleeding, surgery and mortality and early data on high-dose oral PPI suggest improved rebleeding.”
“The non-high-dose PPI regimens, including a broad range of dosing, also improved outcomes, suggesting that doses inferior to those in the high-dose intravenous PPI may be effective.”