A systematic review and meta-analysis published in the Cochrane Database of Systematic Reviews found that initiating proton pump inhibitor (PPI) use prior to endoscopy for upper gastrointestinal bleeding may reduce the need for endoscopic hemostatic treatment but had inconclusive effects on additional outcomes.
Publication databases were searched through June 2021 for randomized clinical trials which compared pre-endoscopic PPI use with placebo or histamine-2 receptor antagonists for mortality, surgical, and bleeding outcomes. This review was performed to expand a prior review conducted in 2010 which included 6 studies. No new studies were identified for this review update.
The included studies were conducted in 1 (n=4) or 2 (n=2) centers in Europe (n=4) or Asia (n=2). The combined sample size for this review was 2223 patients, 1114 of whom were randomly assigned to receive PPIs and 1109 received the control treatment. Among the 5 studies that reported sex, all were dominated by men.
PPI use was associated with a decrease in the need for hemostatic treatment at index endoscopy (odds ratio [OR], 0.68; 95% CI, 0.50-0.93).
PPI use was not observed to have a significant effect on 30-day mortality (OR, 1.14; 95% CI, 0.76-1.70), 30-day rebleeding (OR, 0.81; 95% CI, 0.62-1.06), 30-day surgery (OR, 0.91; 95% CI, 0.65-1.26), or proportion of patients with stigmata or recent hemorrhage at index endoscopy (OR, 0.80; 95% CI, 0.52-1.21).
This review was limited by the fact that no randomized clinical trials published since 2010 met the inclusion criteria.
For most of the clinically relevant mortality and bleeding outcomes, this systematic review and meta-analysis was inconclusive. Additional studies are needed to assess the outcomes of pre-endoscopic PPI use in order to drive evidence-based guidelines and clinical decisions. There was evidence, however, that pre-endoscopic PPI use decreased the need for endoscopic hemostatic treatment.
Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Kanno T, Yuan Y, Tse F, Howden CW, Moayyedi P, Leontiadis GI. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding (Review). Cochrane Database Syst Rev. 2022;1(1):CD005415. doi:10.1002/14651858.CD005415.pub4