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Canadian Journal of Gastroenterology
Volume 23, Issue 4, Pages 287-299
http://dx.doi.org/10.1155/2009/191706
Original Article

Intravenous Pantoprazole as an Adjuvant Therapy following Successful Endoscopic Treatment for Peptic Ulcer Bleeding

Jun Wang,1,2 Kehu Yang,2 Bin Ma,2 Jinhui Tian,2 Yali Liu,2 Zhenggang Bai,2 Lei Jiang,2 Shaoliang Sun,2 Jun Li,2 Ruifeng Liu,2 Xiangyong Hao,2 and Xiaodong He1,2

1Evidence Based Medicine Centre of Lanzhou University, Department of General Surgery, the Second Hospital of Lanzhou University, Lanzhou, China
2Evidence-Based Medicine Centre of Lanzhou University, Lanzhou, China

Received 1 May 2008; Accepted 3 September 2008

Copyright © 2009 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Several studies have suggested that proton pump inhibitors are efficacious in preventing rebleeding when administered immediately after endoscopic treatments. However, there are limited clinical outcome data on the use of intravenous pantoprazole.

OBJECTIVE: To evaluate the efficacy of intravenous pantoprazole after successful endoscopic treatment for peptic ulcer bleeding using evidence from randomized controlled trials (RCTs).

METHODS: The Cochrane Library, MEDLINE, EMBASE and several Chinese databases up to July 2008 were searched. RCTs that compared the relative effectiveness of intravenous pantoprazole with placebo, H2 receptor antagonist or other agents for patients with peptic ulcer bleeding who were pretreated with successful endoscopic therapies were retrieved.

RESULTS: Five RCTs comprising a total of 821 participants were included in the final meta-analysis. Overall, there were significant differences in ulcer rebleeding (RR 0.31; 95% CI 0.18 to 0.53; pooled rates were 4.7% for pantoprazole and 15.0% for control), surgical intervention (RR 0.28, 95% CI 0.09 to 0.83; pooled rates were 1.4% in pantoprazole group versus 6.5% in control) and total length of hospital stay (weighted mean difference −1.53; 95% CI −1.91 to −1.16), but not on mortality (RR 0.72, 95% CI 0.29 to 1.81; pooled mortality rates were 1.9% for pantoprazole versus 2.8% for control) and blood transfusion requirements (weighted mean difference −0.53; 95% CI for random effects −1.04 to −0.02) when compared with control treatments. A series of subgroup analyses supported the results from the main analysis.

CONCLUSIONS: Intravenous administration of pantoprazole after endoscopic therapy for peptic ulcer bleeding reduces rates of ulcer rebleeding, surgical intervention and overall duration of hospital stay, but not mortality and blood transfusion requirements compared with placebo, H2 receptor antagonist or somatostatin.