Oral Proton Pump Inhibitors May Be as Effective as Intravenous in Peptic Ulcer Bleeding: A Systematic Review and Meta-analysis

INTRODUCTION: Current guidelines recommend intravenous (IV) proton pump inhibitor (PPI) therapy in peptic ulcer bleeding (PUB). We aimed to compare the efficacy of oral and IV administration of PPIs in PUB. METHODS: We performed a systematic search in 4 databases for randomized controlled trials, which compared the outcomes of oral PPI therapy with IV PPI therapy for PUB. The primary outcomes were 30-day recurrent bleeding and 30-day mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes, while weighted mean differences (WMDs) with CI were calculated for continuous outcomes in meta-analysis. The protocol was registered a priori onto PROSPERO (CRD42020155852). RESULTS: A total of 14 randomized controlled trials reported 1,951 peptic ulcer patients, 977 and 974 of which were in the control and intervention groups, respectively. There were no statistically significant differences between oral and IV administration regarding 30-day rebleeding rate (OR = 0.96, CI: 0.65–1.44); 30-day mortality (OR = 0.70, CI: 0.35–1.40); length of hospital stay (WMD = −0.25, CI: −0.93 to –0.42); transfusion requirements (WMD = −0.09, CI: −0.07 to 0.24); need for surgery (OR = 0.91, CI: 0.40–2.07); further endoscopic therapy (OR = 1.04, CI: 0.56–1.93); and need for re-endoscopy (OR = 0.81, CI: 0.52–1.28). Heterogeneity was negligible in all analysis, except for the analysis on the length of hospitalization (I(2) = 82.3%, P = 0.001). DISCUSSION: Recent evidence suggests that the oral administration of PPI is not inferior to the IV PPI treatment in PUB after endoscopic management, but further studies are warranted.