Year

Source

N of included studies/patients

Regimen

3-day rebleeding risk

7-day rebleeding risk

Mortality

2010

Wang CH et al. High-dose vs. non-high-dose proton pump inhibitors after endoscopic treatment in patients with bleeding peptic ulcer: a systematic review and meta-analysis of randomized controlled trials [11] .

7 RCT including 1157 patients

80-mg bolus, followed by 8-mg/h continuous infusion for 72 hours. Continuous infusion doses exceeding 192 mg/d were also considered high-dose PPIs. Other doses were considered non-high-dose PPIs.

High-dose PPIs and non-high-dose PPIs did not differ in their effects on the rates of rebleeding OR, 1.30; 95% CI, 0.88 - 1.91.

No difference in mortality, OR 0.89; 95% CI 0.37 - 2.13.

2010

Wu LC et al. High-dose vs. low-dose proton pump inhibitors for upper gastrointestinal bleeding: a meta-analysis. World J Gastroenterol [12] .

9 RCTs, including 1342 patients, were included in the analysis.

The dosage of PPI was considered a high dose if at least twice the low dose of any PPIs was used during the 72 hours following endoscopic hemostasis.

A high-dose PPI regimen is not superior to a low-dose PPI regimen.

A high-dose PPI regimen is not superior to a low-dose PPI regimen.

2013

Neumann I et al. Comparison of different regimens of proton pump inhibitors for acute peptic ulcer bleeding. Cochrane Database Syst Rev [14] .

13 RCTs (1716 patients)

“High” dose regimens are considered 72-hour cumulative doses > 600 mg of intravenous PPI compared to other doses.

Insufficient evidence for concluding results

insufficient evidence for concluding results

2014

Sachar H et al. Intermittent vs. continuous proton pump inhibitor therapy for high-risk bleeding ulcers: a systematic review and meta-analysis [15] .

13 studies included in meta-analysis

80-mg intravenous bolus followed by a continuous 8-mg/h intravenous infusion for 72 hours vs boluses (they could be once daily or more often; oral vs intravenous).

Intermittent PPI regimen is comparable to bolus plus continuous infusions RR < 1

RR for intermittent vs. bolus plus continuous infusion of PPIs was 0.72

RR for mortality < 1

2018

Sgourakis G et al. A meta-analysis and meta-regression analysis. Turk J Gastroenterol [16] .

10 RCTs included 1.651 patients.

A high-dose PPI regimen is identified as an 80 mg bolus followed by intravenous administration of 8 mg/h for 72 h; a low-dose regimen is not specified.

Significantly fewer cases of rebleeding in the low-dose PPI treatment arm

comparable outcomes.