Clinical Question:
Does treatment of patients with ulcer bleeding decrease mortality,
rebleeding, or the need for surgery?
Bottom Line:
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.
Reference:
Systematic review and meta-analysis of proton pump inhibitor therapy in
peptic ulcer bleeding.Leontiadis GI, Sharma VK, Howden CW.BMJ. 2005 Mar
12;330(7491):568.
Study Design:
Meta-analysis (randomized controlled trials)
Synopsis:
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. Systematic review and
meta-analysis was done from Cochrane Collaboration's trials register,
Medline, and Embase, handsearched abstracts, and pharmaceutical companies.
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. 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.
|