What is the best route of PPI delivery in ANVGIB?
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.