Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2015; 21(20): 6341-6351
Published online May 28, 2015. doi: 10.3748/wjg.v21.i20.6341
Proton pump inhibitors therapy vs H2 receptor antagonists therapy for upper gastrointestinal bleeding after endoscopy: A meta-analysis
Ying-Shi Zhang, Qing Li, Bo-Sai He, Ran Liu, Zuo-Jing Li
Ying-Shi Zhang, Qing Li, Bo-Sai He, Ran Liu, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
Zuo-Jing Li, School of Medical Devices, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
Author contributions: Zhang YS collected the data, performed the data analysis and wrote the paper; He BS and Liu R participated in the data collection; Li Q and Li ZJ designed the study and revised the paper; all authors read and approved the final manuscript.
Supported by National Natural Science Funds of China, No. 81102784/H2803; the key project in scientific research from ministry of education, No. 212032 and Liaoning Innovative Research Team in University, No. LT2013022.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qing Li, PhD, School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenhe District, Shenyang 110016, Liaoning Province, China. lqyxm@hotmail.com
Telephone: +86-24-23984392 Fax: +86-24-23984392
Received: August 12, 2014
Peer-review started: August 13, 2014
First decision: September 15, 2014
Revised: September 23, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: May 28, 2015
Abstract

AIM: To compare the therapeutic effects of proton pump inhibitors vs H2 receptor antagonists for upper gastrointestinal bleeding in patients after successful endoscopy.

METHODS: We searched the Cochrane library, MEDLINE, EMBASE and PubMed for randomized controlled trials until July 2014 for this study. The risk of bias was evaluated by the Cochrane Collaboration’s tool and all of the studies had acceptable quality. The main outcomes included mortality, re-bleeding, received surgery rate, blood transfusion units and hospital stay time. These outcomes were estimated using odds ratios (OR) and mean difference with 95% confidence interval (CI). RevMan 5.3.3 software and Stata 12.0 software were used for data analyses.

RESULTS: Ten randomized controlled trials involving 1283 patients were included in this review; 678 subjects were in the proton pump inhibitors (PPI) group and the remaining 605 subjects were in the H2 receptor antagonists (H2RA) group. The meta-analysis results revealed that after successful endoscopic therapy, compared with H2RA, PPI therapy had statistically significantly decreased the recurrent bleeding rate (OR = 0.36; 95%CI: 0.25-0.51) and receiving surgery rate (OR = 0.29; 95%CI: 0.09-0.96). There were no statistically significant differences in mortality (OR = 0.46; 95%CI: 0.17-1.23). However, significant heterogeneity was present in both the numbers of patients requiring blood transfusion after treatment [weighted mean difference (WMD), -0.70 unit; 95%CI: -1.64 - 0.25] and the time that patients remained hospitalized [WMD, -0.77 d; 95%CI: -1.87 - 0.34]. The Begg’s test (P = 0.283) and Egger’s test (P = 0.339) demonstrated that there was no publication bias in our meta-analysis.

CONCLUSION: In patients with upper gastrointestinal bleeding after successful endoscopic therapy, compared with H2RA, PPI may be a more effective therapy.

Keywords: H2 receptor antagonist, Proton pump inhibitor, Upper gastrointestinal bleeding, Randomized controlled trial, Meta-analysis

Core tip: Recently, the administration of proton pump inhibitors (PPI) or H2 receptor antagonists (H2RA) have been used commonly for upper gastrointestinal bleeding patients after successful endoscopic therapy; however, which drug class is more effective, remains controversial. In this meta-analysis, we concluded that in patients with upper gastrointestinal bleeding after successful endoscopic therapy, compared with H2RA, PPI may be a more effective therapy.