Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. May 28, 2010; 16(20): 2558-2565
Published online May 28, 2010. 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, Yun-Fei Cao, Jia-Hao Huang, Cun Liao, Feng Gao
Liu-Cheng Wu, Yun-Fei Cao, Jia-Hao Huang, Cun Liao, Feng Gao, Department of Colorectal and Anal Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Wu LC participated in design of the study, analysis and interpretation of data, manuscript writing, statistical analysis of data, and revision of the manuscript; Cao YF substantially contributed to the conception and design of the study, fund acquisition, administration and materials support; Huang JH, Liao C and Gao F provided supportive contributions.
Supported by First Affiliated Hospital, Guangxi Medical University
Correspondence to: Yun-Fei Cao, PhD, Department of Colorectal and Anal Surgery, First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. caoyunfei126@126.com
Telephone: +86-771-5356529 Fax: +86-771-5356529
Received: January 5, 2010
Revised: February 3, 2010
Accepted: February 10, 2010
Published online: May 28, 2010
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.

Keywords: Meta-analysis; High-dose; Low-dose; Proton pump inhibitors; Gastrointestinal bleeding