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What is the best route of PPI delivery in ANVGIB?

22 Aug 2017

The efficacy of scheduled intravenous (IV) proton pump inhibitors (PPIs) are comparable to that of IV PPI drip for most outcomes in acute nonvariceal upper gastrointestinal bleeding (ANVGIB), a recent systematic review and meta-analysis has found. Moreover, oral PPIs are as effective as scheduled IV for length of stay (LOS) and total units of blood transfused (UBT) and superior to IV PPI drip for risk of surgery (ROS).

Researchers identified a total of 39 studies evaluating acid suppressive medications (IV PPI drip, scheduled IV PPI, oral PPI, H2-receptor antagonists and placebo) in ANVGIB for the following endpoints: risk of rebleeding, LOS, ROS, mortality and total UBT.

Network meta-analysis and Bayesian Markov Chain Monte Carlo methods were used for indirect comparisons and for calculation of probability superiority, respectively.

There was no difference between IV PPI drip and scheduled IV PPI for mortality (relative risk [RR], 1.11; 95 percent credibility interval, 0.56 to 2.21), LOS (RR, 0.04; ‒0.49 to 0.44), ROS (RR, 1.27; 0.64 to 2.35) and risk of rebleeding within 72 hours (RR, 0.98; 0.48 to 1.95), 1 week (RR, 0.59; 0.13 to 2.03) and 1 month (RR, 0.82; 0.28 to 2.16).

In addition, oral PPIs are comparable to schedule IV PPIs and IV PPI drip for LOS (RR, 0.22; ‒0.61 to 0.79 and 0.16; ‒0.56 to 0.80) and UBT (RR, ‒0.25; ‒1.23 to 0.65 and ‒0.06; ‒0.71 to 0.65) and superior to IV PPI drip for ROS (RR, 0.30; 0.10 to 0.78).

“Conclusions should be tempered by low frequency endpoints such as ROS, but question the need for IV PPI drip in ANVGIB,” researchers said.

IV PPIs are the standard medical treatment in ANVGIB, they added.

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Most Read Articles
Elvira Manzano, 3 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
Pearl Toh, 13 Oct 2017
Women with higher plasma tryptophan concentrations were less likely to have poor sleep quality during pregnancy, especially among those with anxiety symptoms, according to the GUSTO* study.
5 days ago
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4 days ago
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