Friday, February 24, 2017

Proton Pump Inhibitors in UGIB

R:E:B:E:L:EM - February 23, 2017
"Upper gastrointestinal bleeding remains a common reason for emergency department visits and is a major cause of morbidity, mortality, and medical care costs. Often when these patients arrive, the classic IV-O2-Monitor is initiated and hemodynamic stability is assessed. One of the next steps often performed includes the initiation of proton pump inhibitors (PPIs).
The ultimate question however is does initiation of PPIs reduce clinically relevant outcomes (i.e. mortality, rebreeding, need for surgical intervention) in upper gastrointestinal bleeds (UGIB)?...
Clinical Bottom Line:
PPI bolus treatment in undifferentiated UGIB DOES NOT improve mortality,* but in the subcategory of proven PUD may improve clinically relevant outcomes such as rebleeding and need for surgical intervention.
* Interestingly, The NNT did a review of this meta-analysis and found that PPIs may have a mortality benefit in the Asian populations and more harmful (or unhelpful) in the European studies."