High-Dose vs. Low-Dose Proton-Pump Inhibitors

Recent guidelines have recommended the use of high-dose proton-pump inhibitors (PPIs) to reduce the risk for rebleeding in patients with bleeding peptic ulcers and endoscopic stigmata for rebleeding. Some data suggest that low-dose PPI therapy might also reduce rebleeding in such patients (JW Gastroenterol Feb 20 2009). However, whether high-dose PPI therapy is superior to low-dose PPI therapy is unknown.

To address this issue, investigators performed a meta-analysis of randomized controlled trials that compared the effectiveness of high-dose PPIs (80-mg bolus followed by continuous intravenous infusion ≥8 mg/hour for 72 hours) versus lower-doses (that varied) to reduce rates of rebleeding, surgical therapy, and 30-day mortality after endosc…