Intended for healthcare professionals

Papers

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

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38356.641134.8F (Published 10 March 2005) Cite this as: BMJ 2005;330:568
  1. Grigoris I Leontiadis, consultant gastroenterologist1,
  2. Virender K Sharma, associate professor2,
  3. Colin W Howden (c-howden{at}northwestern.edu), professor3
  1. 1 Department of Gastroenterology, University Hospital of North Durham, Durham DH1 5TW
  2. 2 Division of Gastroenterology, Mayo Clinic, Scottsdale, AZ 85259, USA
  3. 3 Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
  1. Correspondence to: CW Howden
  • Accepted 17 December 2004

Abstract

Objectives 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.

Design Systematic review and meta-analysis.

Data sources Cochrane Collaboration's trials register, Medline, and Embase, handsearched abstracts, and pharmaceutical companies.

Review methods Included randomised controlled trials 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. Two assessors independently reviewed each trial, and disagreements were resolved by consensus.

Results We included 21 randomised controlled trials comprising 2915 patients. Proton pump inhibitor treatment had no significant effect on mortality (odds ratio 1.11, 95% confidence interval 0.79 to 1.57; number needed to treat (NNT) incalculable) but reduced rebleeding (0.46, 0.33 to 0.64; NNT 12) and surgery (0.59, 0.46 to 0.76; NNT 20). Results were similar when the meta-analysis was restricted to the 10 trials with the highest methodological quality: 0.96, 0.46 to 2.01, for mortality; 0.41, 0.25 to 0.68, NNT 10, for rebleeding; 0.62, 0.46 to 0.83, NNT 25, for surgery.

Conclusions 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.

Footnotes

  • Contributors GIL and CWH were involved in the composition and design of the systematic review and meta-analysis, the analysis and interpretation of the data, drafting of the article, critical revision of the article for intellectual content, final approval of the article, and collection and assembly of the data. VKS was involved in the composition and design of the systematic review and meta-analysis, critical revision of the article for intellectual content, final approval of the article, and assisted with the statistical analysis. CWH is guarantor.

  • Funding There was no external funding for this work.

  • Competing interests VKS has received research grants from TAP Pharmaceutical Products and speaking honorariums from AstraZeneca and TAP. CWH is a consultant for TAP Pharmaceutical Products, Santarus, and Schwarz Pharma; has received grant support from AstraZeneca, TAP, and Janssen; has been a trial investigator for AstraZeneca, TAP, and Merck; and has received speaking honorariums from TAP, Merck, AstraZeneca, Wyeth, and Novartis.

  • Ethical approval Not required.

View Full Text