CHIH-HUNG WANGMATTHEW HUEI-MING MAChou H.-C.ZUI-SHEN YENCHIH-WEI YANGCHENG-CHUNG FANGSHYR-CHYR CHEN2020-12-282020-12-2820100003-9926https://scholars.lib.ntu.edu.tw/handle/123456789/533432Background: High-dose proton pump inhibitors (PPIs) (80-mg bolus, followed by 8-mg/h continuous infusion for 72 hours) have been widely studied and used. However, to date no concrete evidence has shown that high-dose PPIs are more effective than non-high-dose PPIs. Methods: We performed a literature search for randomized controlled trials that compared the use of high-dose PPIs vs non-high-dose PPIs in patients with bleeding peptic ulcer and determined their effects on rebleeding, surgical intervention, and mortality. Outcomes data were combined in a meta-analysis and were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: A total of 1157 patients from 7 high-quality randomized studies were included in this meta-analysis. High-dose PPIs and non-high-dose PPIs did not differ in their effects on the rates of rebleeding (7 studies and 1157 patients; OR, 1.30; 95% CI, 0.88-1.91), surgical intervention (6 studies and 1052 patients; 1.49; 0.66-3.37), or mortality (6 studies and 1052 patients; 0.89; 0.37-2.13). Post hoc subgroup analyses revealed that summary outcomes measures were unaffected by severity of signs of recent hemorrhage at initial endoscopy, route of PPI administration, or PPI dose. Conclusion: Compared with non-high-dose PPIs, high-dose PPIs do not further reduce the rates of rebleeding, surgical intervention, or mortality after endoscopic treatment in patients with bleeding peptic ulcer. ? American Medical Association. All rights reserved.[SDGs]SDG3esomeprazole; lansoprazole; omeprazole; pantoprazole; proton pump inhibitor; rabeprazole; clinical trial; continuous infusion; dose response; drug megadose; endoscopic therapy; human; meta analysis; mortality; peptic ulcer bleeding; priority journal; review; systematic review; treatment outcome; Aged; Dose-Response Relationship, Drug; Endoscopy; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Peptic Ulcer Hemorrhage; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Recurrence; Survival Ratereview10.1001/archinternmed.2010.100204580812-s2.0-77952172715