Ovid: Bustamante: J Clin Gastroenterol, Volume 30(1).January 2000.7-13 http://gateway.ut.ovid.com.myaccess.library.utoronto.ca/gw1/ovidweb.cgi 1 of 11 2/24/2007 8:07 PM © 2000 Lippincott Williams & Wilkins, Inc. Volume 30(1), January 2000, pp 7-13 The Efficacy of Proton-pump Inhibitors in Acute Ulcer Bleeding: A Qualitative Review [Clinical Reviews: Esophageal And Gastric Diseases] Bustamante, Manuel M.D.; Stollman, Neil M.D., F.A.C.P., F.A.C.G. From the Department of Medicine (M.B.), University of Miami School of Medicine, Miami, Florida; and the Division of Gastroenterology (N.S.), University of Miami School of Medicine and Miami VA Medical Center, Miami, Florida. Address correspondence and reprint requests to Dr. Neil H. Stollman, Division of Gastroenterology (D-1007), Miami VA Medical Center, 1201 NW 16th Street, Miami, FL 33125. Abstract Despite remarkable progress in the treatment of chronic peptic ulcer disease, acute gastroduodenal ulcer hemorrhage remains a therapeutic challenge. Numerous trials of H-2 receptor antagonists have not consistently shown a significant benefit in such patients. Proton-pump inhibitors, which more profoundly suppress gastric acid, are being increasingly evaluated. We have performed a qualitative systematic review to analyze the results of these trials to determine if a reasonable consensus can be reached. We searched for all published, randomized, controlled studies that evaluated proton-pump inhibitors in patients with acute peptic ulcer hemorrhage. The primary outcomes evaluated were: (A) persistent or recurrent bleeding; (B) need for surgery; and (C) mortality. Sixteen trials were evaluated, enrolling 3154 patients. Four of the sixteen studies showed a statistically significant decrease in overall rebleeding rate, and two described specific benefit in patients with Type IIa and IIb endoscopic stigmata. Four studies also showed a significantly decreased surgery rate, but none demonstrated a significant mortality reduction. Proton-pump inhibitors may improve outcome in acute peptic ulcer bleeding, but the available clinical data remain inconsistent. Further study is necessary to define the optimal dosage, route of administration, duration of therapy, and subsets of patients most likely to benefit. Bleeding in the upper gastrointestinal (UGI) tract causes significant morbidity and mortality, with an overall incidence of approximately 150 hospital admissions per 100,000 population per year.1 Mortality from acute UGI bleeding has remained at 6-10% despite improved medical and surgical treatments, the development of diagnostic and therapeutic endoscopy, and the use of intensive care units.2 One contributing factor might be that patients with acute UGI bleeding tend to be older, with more co-morbid illnesses. 1 Furthermore, the widespread use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) has also substantially increased the risk of bleeding and its potential morbidity.3 Fortunately, bleeding stops spontaneously in the majority of patients with UGI bleeding. However, patients with continued or recurrent bleeding pose the greatest challenge. For these patients, endoscopic techniques (injection therapy, thermal, and laser treatment) are widely