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  • Proton pump inhibitors given before endoscopy for upper gastrointestinal bleeding do not improve survival, rebleeding or need for surgery

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Therapeutics
Systematic review
Proton pump inhibitors given before endoscopy for upper gastrointestinal bleeding do not improve survival, rebleeding or need for surgery
  1. Patrick Yachimski
  1. Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Patrick Yachimski
    1660 The Vanderbilt Clinic, Nashville, TN 37232-5280, USA; patrick.yachimski{at}vanderbilt.edu

https://doi.org/10.1136/ebm1133

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    Commentary on:

    1. Sreedharan A,
    2. Martin J,
    3. Leontiadis GI,
    4. et al
    . Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev 2010;7:CD005415.

    Context

    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.

    Methods

    A detailed search of published and unpublished studies identified six randomised controlled trials (RCTs), enrolling a sum of 2223 participants with overt upper gastrointestinal haemorrhage which met strict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 …

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    Footnotes

    • Competing interests None.