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Review
. 2016 Sep;82(3):880-9.
doi: 10.1111/bcp.12866. Epub 2016 Jun 12.

Is the era of intravenous proton pump inhibitors coming to an end in patients with bleeding peptic ulcers? Meta-analysis of the published literature

Zhixiang Jian  1 , Hui Li  2 , Nicholas S Race  3 , Tingting Ma  4 , Haosheng Jin  1 , Zi Yin  1
Affiliations
Review

Is the era of intravenous proton pump inhibitors coming to an end in patients with bleeding peptic ulcers? Meta-analysis of the published literature

Zhixiang Jian et al. Br J Clin Pharmacol. 2016 Sep.

Abstract

Aims: Oral and intravenous proton pump inhibitors (PPIs) are equipotent in raising gastric pH. However, it is not known whether oral PPIs can replace intravenous PPIs in patients with bleeding peptic ulcers.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials to compare oral and intravenous PPIs among patients with peptic ulcer bleeding. A search of all major databases and relevant journals from inception to April 2015, without a restriction on languages, was performed.

Results: A total of 859 patients from seven randomized controlled trials were included in the meta-analysis. Similar pooled outcome measures were demonstrated between the two groups in terms of oral PPIs vs. intravenous PPIs in the rate of recurrent bleeding within the 30-day follow-up period [risk ratio = 0.90; 95% confidence interval (CI): 0.58, 1.39; P = 0.62; I(2) = 0%). In terms of the rate of mortality, both oral and intravenous PPIs showed similar outcomes, and the pooled risk ratio was 0.88 (95% CI: 0.29, 2.71; P = 0.82; I(2) = 0%). Likewise, no significant difference was detected in the need for blood transfusion and length of hospital stay; the pooled mean differences were -0.14 (95% CI: -0.39, 0.12; P = 0.29; I(2) = 32%) and -0.60 (95% CI: -1.42, 0.23; P = 0.16; I(2) = 79%), respectively.

Conclusions: Our results suggest that oral PPIs are a feasible, safe alternative to intravenous PPIs in patients with bleeding peptic ulcers, and may be able to replace intravenous PPIs as the treatment of choice in these patients.

Keywords: bleeding peptic ulcers; intravenous; oral; proton pump inhibitors.

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Figures

Figure 1
Figure 1
Flowchart of publication search and selection
Figure 2
Figure 2
Risks of bias in the trials included in the meta‐analysis
Figure 3
Figure 3
Oral proton pump inhibitor (PPI) vs. intravenous PPI in the rate of recurrent bleeding within a 30‐day follow‐up period. CI, confidence interval; IVP, intravenous PPI; ORP, oral PPI; M‐H, Mantel‐Haenszel method
Figure 4
Figure 4
Oral proton pump inhibitor (PPI) vs. intravenous PPI in the rate of mortality within a 30‐day follow‐up period. CI, confidence interval; IVP, intravenous PPIs; ORP, oral PPIs; M‐H, Mantel‐Haenszel method
Figure 5
Figure 5
Oral proton pump inhibitor (PPI) vs. intravenous PPI in blood transfusion within a 30‐day follow‐up period. CI, confidence interval; IV, intravenous; IVP, intravenous PPI; ORP, oral PPI
Figure 6
Figure 6
Oral proton pump inhibitor (PPI) vs. intravenous PPI in length of hospital stay. CI, confidence interval; IV, intravenous; IVP, intravenous PPI; ORP, oral PPI
Figure 7
Figure 7
Symmetry of Funnel plot depicted little publication bias in trials included in the meta‐analysis
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