cqvip:Objectives: To review randomised controlled trials of treat- ment with a proton pump inhibitor in patients with ulcer bleeding and to deter mine the impact on mortality,rebleedi- ng, and surgical intervention. Design: Systematic review and meta-analysis. D ata sources: Cochrane Collaboration’s trials register, Medline, and Embase,hand searched abstracts, and pharmaceutical companies.Review methods: Included random ised controlled trials that compared proton pump inhibitor with placebo or H2 re ceptor antagonist in endoscopically proved bleeding ulcer and reported at least one of mortality, rebleeding, or surgical intervention. Trials were graded for m ethodological quality. Two assessors independently reviewed each trial, and disa greements were resolved by consensus.Results:We included 21 randomised controll ed trials comprising 2915 patients. Proton pump inhibitor treatment had no signi ficant effect on mortality (odds ratio 1.11, 95%confidence interval 0.79 to 1.5 7; number needed to treat(NNT) incalculable) but reduced rebleeding (0.46, 0.33 to 0.64; NNT 12) and surgery (0.59,0.46 to 0.76; NNT 20). Results were similar w hen the meta-analysis was restricted to the 10 trials with the highest methodol ogical quality: 0.96, 0.46 to 2.01, for mortality; 0.41, 0.25 to 0.68, NNT 10, f or rebleeding; 0.62, 0.46 to 0.83, NNT 25,for surgery. Conclusions: Treatment wi th a proton pump inhibitor reduces the risk of rebleeding and the requirement fo r surgery after ulcer bleeding but has no benefit on overall mortality.
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