Data were also collected on the Forrest classification of the PUB, details of endoscopic procedure before PPI treatment, PPI therapy before endoscopic diagnosis and treatment, type of the oral PPI therapy after the intervention/comparator PPI, the oral and IV treatment regimes (doses, timing, and other specifics of the drugs). Data were collected on the year of publication, study and publication type, geographical location, number of cases and controls, and basic demographics (age and sex). Disagreements were resolved by consensus and the involvement of the corresponding author (B.E.).ĭata were extracted and manually introduced into a purpose-designed Excel sheet (Office 365 Microsoft, Redmond, WA). and H.S.) independently extracted relevant data. Given the above-detailed issues with IV administration and the advantages of oral administration, we wanted to compare the efficacy of the 2 administration routes in RCTs and analyze whether future RCTs are needed.įrom the eligible studies, 2 review authors (E.C. Finally, the same dose of IV PPI can cost many times more than oral ( 9). IV medication carries significantly more iatrogenic risks than their oral equivalents. The management of IV cannula needs specially trained nursing staff, while the continuous infusion reduces the mobility and the comfort of the patients. Long-term IV cannulation may result in thrombophlebitis and can serve as a gateway for other infections. IV administration of PPI is more complicated compared with the oral route. ( 8) from 2014 focused on the continuous and intermittent IV administration of PPIs and found that intermittent PPI therapy is comparable with the current guideline recommended regime in patients with endoscopically treated high-risk bleeding ulcers. However, both analyses had several limitations.Ī third meta-analysis by Sachar et al. These meta-analyses concluded that oral PPI is an equally safe treatment option after the initial endoscopic management. The meta-analysis from 2016 included 7 randomized controlled trials (RCTs) with 859 patients, and the other one from 2017 included 9 RCTs with 1,036 patients. Since the publication of the above guidelines, 2 meta-analyses investigated the differences in outcomes between the oral and IV administration of PPIs ( 6, 7). The American Society of Gastrointestinal Endoscopy guideline from 2012 does recommend IV PPI and does not mention oral administration as a possible treatment option ( 5). The American College of Gastroenterology guideline from 2012 advocates that only patients with low-risk ulcers can receive oral PPI therapy instead of IV one ( 4).
The European Society of Gastrointestinal Endoscopy guideline from 2015 cautiously intimates that if the patient's condition permits, high-dose oral PPI may be an alternative in those able to tolerate oral medications ( 3). PUB management is based on 2 methods: urgent endoscopy and, if necessary, endoscopic hemostasis and conservative treatment after that.Ĭurrent protocols recommend 3 days of treatment with intravenous (IV) proton pump inhibitor (PPI), but in cases where patients tolerate it, oral treatment may also be considered.
A common source of upper gastrointestinal bleeding is peptic ulcer bleeding (PUB), with a prevalence of 30% ( 1), and it has a high mortality, estimated between 3% and 14% ( 2).