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Benefit of Route and Dose of Administration of Proton Pump Inhibitor in Acute Nonvariceal Upper Gastrointestinal Bleeding-A Network Meta-Analysis FREE TO VIEW

Kerry-Ann Cadogan, MD; Elie Donath, MD; Ravikanth Tadi, MD; Eduardo Rodriguez, MD; Daniel Sussman, MD
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Department of Internal Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, Atlantis, FL

Chest. 2013;144(4_MeetingAbstracts):362A. doi:10.1378/chest.1704053
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SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Non-variceal upper gastrointestinal (GI) bleeding is a common cause of hospital visits and ICU admissions. Little is known about the preferred dosing and route of proton-pump inhibitors (PPI) administration (i.e., continuous intravenous [IV] infusion vs IV bolus vs oral). The aim of this network meta-analysis was to determine whether any difference in rebleeding rate or mortality exists among these forms of PPI delivery.

METHODS: Randomized controlled trials comparing PPI delivery in acute non-variceal upper GI bleeding were extracted from a search of MEDLINE and EMBASE. A mixed-treatment comparisons analysis was constructed to indirectly compare each of these treatment classes. Calculation of the probability that each treatment was superior was performed using the Bayesian Markov chain Monte Carlo method. The primary outcomes of interest was rebleeding rate after 72 hours. Other endpoints considered were rebleeding rate after one week, rebleeding rate at one month, mortality, hospitalization days, need for surgical intervention, and units of blood transfused

RESULTS: 40 trials were identified, including studies comparing PPIs to placebo and H2-blockers. No difference in rebleeding rate at 72 hours among PPI administration dosing or route was found (the relative risk of rebleeding for patients receiving continuous PPI infusion was 0.98 (95% CI: 0.48-1.95, p=0.57) compared to bolus PPI dosing and 0.87 (95% CI: 0.31-2.16, p=0.41) compared to oral PPI). Among secondary endpoints, risk of surgery was statistically significantly reduced among patients receiving oral PPI compared to continuous PPI infusion (RR: 0.30, 95% CI: 0.10-0.78, p=0.003) and bolus PPI dosing (RR=0.38, 95% CI 0.04-0.95, p=0.02). No further differences were identified among all other secondary endpoints .

CONCLUSIONS: No advantage was demonstrated among continuous IV infusion, IV bolus, and oral PPI for all outcomes.

CLINICAL IMPLICATIONS: These results support the utility of clinician preference in selecting the route of PPI delivery for acute non-variceal upper GI bleeding.

DISCLOSURE: The following authors have nothing to disclose: Kerry-Ann Cadogan, Elie Donath, Ravikanth Tadi, Eduardo Rodriguez, Daniel Sussman

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