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Proton pump inhibitors (PPI) have an important role in the treatment of upper gastrointestinal haemorrhage and in the healing and maintenance of peptic ulcer disease. Recent international guidelines, based on expert consensus, recommend that PPI should be considered prior to endoscopy in patients with non-variceal upper gastrointestinal haemorrhage.1 Sreedharan and colleagues have thus conducted a systematic literature review and meta-analysis assessing the impact of pre-endoscopic PPI therapy on meaningful clinical outcomes.
A detailed search of published and unpublished studies identified six randomised controlled trials (RCTs), enrolling a sum of 2223 participants with overt upper gastrointestinal haemorrhage which met strict criteria for inclusion in the meta-analysis, and in which the treatment arm consisted of PPI prior to endoscopy, and the control arm consisted of either placebo, histamine receptor antagonist or no treatment prior to endoscopy. The primary outcome was all-cause …