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Intravenous vs. Oral Proton-Pump Inhibitors for Bleeding Peptic Ulcers

Summary and Comment |
August 16, 2013

Intravenous vs. Oral Proton-Pump Inhibitors for Bleeding Peptic Ulcers

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Results of a meta-analysis suggest equal effectiveness but require validation in a larger study.

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

The use of proton-pump inhibitors (PPIs) has been shown to decrease rebleeding in patients with bleeding peptic ulcers (PUB) and high-risk stigmata for rebleeding. In most studies, patients have received intravenous (IV) PPIs for 3 days after endoscopic therapy. Few studies have compared oral with IV therapy in this setting.

To investigate this issue, researchers conducted a systematic review and meta-analysis of available studies. They identified six randomized, prospective studies in which clinical outcomes were compared in 615 patients with PUB (mean age, 60; 71% men) who received oral or IV PPIs.

The pooled data showed no difference in rebleeding, blood transfusions, surgery, or all-cause mortality. Length of stay was shorter for patients receiving oral PPIs. Subgroup analyses of high-dose IV administration of PPIs and of patients with severe stigmata showed no differences in any of the outcomes.

Comment

Determining the optimal delivery method for proton-pump inhibitors has potential significance with regard to the cost of care and length of stay, as the standard of care for intravenous therapy is 72 hours of continuous infusion. Although these findings suggest that both oral and IV delivery methods are effective in the treatment of bleeding peptic ulcers, their validity is questionable. The studies included in the meta-analysis were small and of poor quality. Also, different endoscopic therapies were used, and some studies included patients with low-risk stigmata, who do not benefit from PPI treatment. As the authors note, a large, well-designed trial comparing delivery methods is needed to settle this issue.

  • Disclosures for David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) at time of publication Leadership positions in professional societies World Gastroenterology Organization (Treasurer)

Citation(s):

Reader Comments (2)

MOHAMMAD NAFFAA Physician, Internal Medicine, Rambam Health Care Campus

head to head comparison should examined in a large scale studies before adapting the oral route as the standard of care

DIANA GANCHEVA Physician, Gastroenterology

In our clinic we use i.v. PPI for bleeding peptic ulcer for 3 to 5 days, following with oral PPI.

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