Upper GI bleeding: peptic ulcers: acid suppression reduces rebleeding and surgery, but not death

Clinical bottom line (level 1a)

  1. Patients with upper GI bleeding due to peptic ulcers who receive acid suppression compared with placebo are less likely to rebleed or require surgery.
  2. There is no clear effect on mortality.
Selby et al: Aliment Pharmacol Ther 2000; 14 : 1119-1126
Expires January 2004

The study

Systematic review of all randomised placebo-controlled trials of
  • Patients: upper GI bleeding due to a peptic ulcer
  • Intervention: acid-decreasing agents: H-2 receptor antagonists, proton pump inhibitors, antacids compared with placebo
  • Outcome: rebleeding, surgery, death

    Articles found in English using Medline, 1980 to 1999 (search terms: ) and searching bibliographies of retrieved articles

    Selection criteria: by 2 independent reviewers: see above and below
    Appraisal criteria: randomised, placebo-controlled
    Articles excluded if:
    • patients received alternative potentially-effective therapy
    • large numbers of patients excluded
    • bleeding not due to peptic ulcer disease


    21 randomised controlled trials found involving 3566 patients

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NN?
    (% CI)
    rebleeding weeks /
    (%)    		 0.727
    (0.618 to 0.855)
    surgery weeks /
    (%)    		 0.707
    (0.582 to 0.859)
    death weeks /
    (%)    		 1.14
    (0.818 to 1.59)

    Comments

    1. By limiting the search to English and Medline means that important articles may have been missed.

    Citation

    1. Selby NM, Kubba AK, Hawkey CJ: acid suppression in peptic ulcer haemorrhage: a 'meta-analysis'. Aliment Pharmacol Ther 2000; 14 : 1119-1126
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, January 2002
    Reviewer:

    Clinical Question.
    Patient peptic ulcer haemorrhage
    Intervention or Exposure acid suppression
    Outcome death, surgery, rebleeding
    		•