PRESENTATION OUTLINE
INTERMITTENT vs CONTINUOUS PPI THERAPY FOR HIGH-RISK BLEEDING ULCERS
A Systematic Review and Meta-Analysis
JAMA Intern Med. 2014;174(11):1755
Established guidelines:
IV bolus PPI followed by continuous infusion for high-risk ulcers
High risk = active bleeding, non bleeding visible vessels, adherent clots
Data sources:
MEDLINE
EMBASE
Cochrane Database
Gastroenterology abstracts
STUDY DESIGN
RCTs of pts with endoscopically treated high-risk bleeding ulcers
Primary outcome:
Rebleeding within 7 days
2° outcomes:
Need for urgent intervention, mortality, transfusion, length of stay
INTERVENTION + COMPARISON
RESULTS
10 trials reported on recurrent bleeding
→ 1 reported a statistically significant difference in favour of intermittent bolus
9 trials reported recurrent bleeding at 3 days
1/9 showed significant difference in favour of intermittent regimen
Intermittent PPI:
Easier to use
Lower cost and resource utilisation
PPI infusion:
Dedicated lumen
Staffing requirements
More expensive
Issues:
Only post-endoscopy
8/13 unblinded
Multiple PPIs, no std. regimen
