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Meta-Analysis
. 2010 May 28;16(20):2558-65.
doi: 10.3748/wjg.v16.i20.2558.

High-dose vs low-dose proton pump inhibitors for upper gastrointestinal bleeding: a meta-analysis

Liu-Cheng Wu  1 , Yun-Fei Cao, Jia-Hao Huang, Cun Liao, Feng Gao
Affiliations
Meta-Analysis

High-dose vs low-dose proton pump inhibitors for upper gastrointestinal bleeding: a meta-analysis

Liu-Cheng Wu et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the efficacy of high-dose proton pump inhibitors (PPIs) vs low-dose PPIs for patients with upper gastrointestinal bleeding.

Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched to identify relevant randomized controlled trials (RCTs). Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic hemostasis. The primary endpoint was rebleeding; secondary endpoints were patient numbers that needed surgery, and mortality. The meta-analysis was performed with a fixed effects model or random effects model.

Results: Nine eligible RCTs including 1342 patients were retrieved. The results showed that high-dose intravenous PPI was not superior to low-dose intravenous PPI in reducing rebleeding [odds ratio (OR) = 1.091, 95% confidential interval (CI): 0.777-1.532], need for surgery (OR = 1.522, 95% CI: 0.643-3.605) and mortality (OR = 1.022, 95% CI: 0.476-2.196). Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients (OR = 0.831, 95% CI, 0.467-1.480) and European patients (OR = 1.263, 95% CI: 0.827-1.929).

Conclusion: Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.

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Figures

Figure 1
Figure 1
Flow chart of the literature search for this meta-analysis.
Figure 2
Figure 2
Meta-analysis results of randomized clinical trials comparing high-dose proton pump inhibitor (PPI) vs low-dose PPI in rebleeding (A), surgery (B) and mortality (C).
See this image and copyright information in PMC

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