Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2009 Apr;23(4):287-99.
doi: 10.1155/2009/191706.

Intravenous pantoprazole as an adjuvant therapy following successful endoscopic treatment for peptic ulcer bleeding

Jun Wang  1 , Kehu Yang, Bin Ma, Jinhui Tian, Yali Liu, Zhenggang Bai, Lei Jiang, Shaoliang Sun, Jun Li, Ruifeng Liu, Xiangyong Hao, Xiaodong He
Affiliations
Review

Intravenous pantoprazole as an adjuvant therapy following successful endoscopic treatment for peptic ulcer bleeding

Jun Wang et al. Can J Gastroenterol. 2009 Apr.

Abstract
in English, French

Background: Several studies have suggested that proton pump inhibitors are efficacious in preventing rebleeding when administered immediately after endoscopic treatments. However, there are limited clinical outcome data on the use of intravenous pantoprazole.

Objective: To evaluate the efficacy of intravenous pantoprazole after successful endoscopic treatment for peptic ulcer bleeding using evidence from randomized controlled trials (RCTs).

Methods: The Cochrane Library, MEDLINE, EMBASE and several Chinese databases up to July 2008 were searched. RCTs that compared the relative effectiveness of intravenous pantoprazole with placebo, H2 receptor antagonist or other agents for patients with peptic ulcer bleeding who were pretreated with successful endoscopic therapies were retrieved.

Results: Five RCTs comprising a total of 821 participants were included in the final meta-analysis. Overall, there were significant differences in ulcer rebleeding (RR 0.31; 95% CI 0.18 to 0.53; pooled rates were 4.7% for pantoprazole and 15.0% for control), surgical intervention (RR 0.28, 95% CI 0.09 to 0.83; pooled rates were 1.4% in pantoprazole group versus 6.5% in control) and total length of hospital stay (weighted mean difference -1.53; 95% CI -1.91 to -1.16), but not on mortality (RR 0.72, 95% CI 0.29 to 1.81; pooled mortality rates were 1.9% for pantoprazole versus 2.8% for control) and blood transfusion requirements (weighted mean difference -0.53; 95% CI for random effects -1.04 to -0.02) when compared with control treatments. A series of subgroup analyses supported the results from the main analysis.

Conclusions: Intravenous administration of pantoprazole after endoscopic therapy for peptic ulcer bleeding reduces rates of ulcer rebleeding, surgical intervention and overall duration of hospital stay, but not mortality and blood transfusion requirements compared with placebo, H2 receptor antagonist or somatostatin.

HISTORIQUE :: Plusieurs études laissent supposer que les inhibiteurs de la pompe à protons sont efficaces pour prévenir des récidives d’hémorragie s’ils sont administrés immédiatement après les traitements endoscopiques. Cependant, on possède peu de données d’issues cliniques sur l’utilisation du pantoprazole par intraveineuse (IV).

OBJECTIF :: Évaluer l’efficacité du pantoprazole IV après le traitement endoscopique réussi de l’hémorragie d’un ulcère gastroduodénal au moyen de données probantes tirées d’essais aléatoires et contrôlés (EAC).

MÉTHODOLOGIE :: Les auteurs ont fait des recherches dans la Bibliothèque Cochrane, MEDLINE, EMBASE et plusieurs bases de données chinoises jusqu’à juillet 2008. Ils ont extrait les EAC dans lesquels on comparait l’efficacité relative du pantoprazole IV à un placebo, à un antagoniste des récepteurs H2 ou à d’autres agents chez des patients souffrant d’hémorragie attribuable à un ulcère gastroduodénal ayant déjà été traités avec succès par endoscopie.

RÉSULTATS :: La méta-analyse finale incluait cinq EAC, pour un total de 821 participants. Dans l’ensemble, par rapport aux sujets témoins, on constatait une différence significative pour ce qui est des récidives d’hémorragie de l’ulcère (RRR 0,31; 95 % IC 0,18 à 0,53; les taux regroupés s’élevaient à 4,7 % dans le groupe prenant du pantoprazole et à 15,0 % dans le groupe témoin), des interventions chirurgicales (RRR 0,28; 95 % IC 0,09 à 0,83; les taux regroupés s’élevaient à 1,4 % dans le groupe prenant du pantoprazole et à 6,5 % dans le groupe témoin) et de l’hospitalisation totale (différence moyenne pondérée −1,53; 95 % IC −1,91 à −1,16), mais non pour ce qui est de la mortalité (RRR 0,72; 95 % IC 0,29 à 1,81; les taux de mortalité regroupés s’élevaient à 1,9 % dans le groupe prenant du pantoprazole et à 2,8 % dans le groupe témoin) et des besoins de transfusion sanguine (différence moyenne pondérée −0,53; 95 % IC pour les effets aléatoires −1,04 à −0,02). Une série d’analyses de sous-groupes a corroboré les résultats de l’analyse principale.

CONCLUSIONS :: L’administration de pantoprazole IV après le traitement endoscopique de l’hémorragie d’un ulcère gastroduodénal réduit les taux de récidive d’hémorragie de l’ulcère, d’intervention chirurgicale et la durée des hospitalisations, mais non la mortalité et les besoins de transfusion sanguine par rapport à un placebo, à un antagoniste des récepteurs H2 ou à la somostatine.

PubMed Disclaimer

Figures

Figure 1)
Figure 1)
Ulcer rebleeding (main analysis). Intravenous pantoprazole as an adjuvant therapy following successful endoscopic treatment for peptic ulcer bleeding. df Degrees of freedom
Figure 2)
Figure 2)
Ulcer rebleeding (subgroup analysis). df Degrees of freedom. Ulcer rebleeding (subgroup analysis). df Degrees of freedom; IV Intravenous; VS Versus
Figure 2)
Figure 2)
Ulcer rebleeding (subgroup analysis). df Degrees of freedom. Ulcer rebleeding (subgroup analysis). df Degrees of freedom; IV Intravenous; VS Versus
Figure 3)
Figure 3)
Mortality (main analysis). df Degrees of freedom
Figure 4)
Figure 4)
Mortality (subgroup analysis). df Degrees of freedom; IV Intravenous; VS Versus
Figure 5)
Figure 5)
Need for surgery (main analysis). df Degrees of freedom
Figure 6)
Figure 6)
Need for surgery (subgroup analysis). df Degress of freedom; IV Intravenous; VS Versus
Figure 7)
Figure 7)
Blood transfusion requirements (main analysis). df Degrees of freedom; WMD Weighted mean difference
Figure 8)
Figure 8)
Blood transfusion requirements (subgroup analysis). df Degrees of freedom; IV Intravenous; VS Versus; WMD Weighted mean difference
Figure 9)
Figure 9)
Total duration of hospital stay (main analysis). df Degrees of freedom; WMD Weighted mean difference
Figure 10)
Figure 10)
Total duration of hospital stay (subgroup analysis). df Degrees of freedom; IV Intravenous; VS Versus; WMD Weighted mean difference
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Saltzman JR, Zawacki JK. Therapy for bleeding peptic ulcers. N Engl J Med. 1997;336:1091–3. - PubMed
    1. Selby NM, Kubba AK, Hawkey CJ. Acid suppression in peptic ulcer haemorrhage: A ‘meta-analysis’. Aliment Pharmacol Ther. 2000;14:1119–26. - PubMed
    1. Higham J, Kang JY, Majeed A. Recent trends in admissions and mortality due to peptic ulcer in England: Increasing frequency of haemorrhage among older subjects. Gut. 2002;50:460–4. - PMC - PubMed
    1. Paimela H, Paimela L, Myllykangas-Luosujärvi R, et al. Current features of peptic ulcer disease in Finland: Incidence of surgery, hospital admissions and mortality for the disease during the past twenty-five years. Scand J Gastroenterol. 2002;37:399–403. - PubMed
    1. van Leerdam ME, Vreeburg EM, Rauws EA, et al. Acute upper GI bleeding: Did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol. 2003;98:1494–9. - PubMed

MeSH terms

Substances

LinkOut - more resources