Benefits Found Lacking for High-Dose Proton Pump Inhibitors

Other studies link PPIs to increased incidence of fractures, infection
By Jeff Muise
HealthDay Reporter

TUESDAY, May 11 (HealthDay News) -- Treatment with high doses of proton pump inhibitors (PPIs) is not associated with reduced rates of rebleeding, surgical intervention, or death in patients with bleeding peptic ulcers compared to non-high-dose PPI treatment, according to a meta-analysis published in the May 10 issue of the Archives of Internal Medicine alongside several other studies that explore the side effects associated with PPIs.

Chih-Hung Wang, M.D., of the National Taiwan University in Taipei, and colleagues analyzed seven randomized studies, including 1,157 subjects, that compared the use of high-dose PPIs (including omeprazole, sodium/magnesium, pantoprazole sodium, lansoprazole, rabeprazole sodium, and esomeprazole sodium/magnesium) and non-high-dose PPIs in patients with bleeding peptic ulcer who had had endoscopic treatment.

The researchers found that treatment with high-dose PPIs and non-high-dose PPIs did not differ significantly for rates of rebleeding (odds ratio [OR], 1.30), surgical intervention (OR, 1.49), or mortality (OR, 0.89). In subgroup analyses, the results did not change when severity of signs of recent hemorrhage and the method of medication administration were factored in. Other studies in the journal's series examining health care overuse found that PPIs may increase the risk of fracture in postmenopausal women, and that daily PPI use is associated with an increase in Clostridium difficile infection.

"We anticipate the performance of more high-quality randomized controlled trials that will include diverse racial/ethnic groups, standardized endoscopic diagnosis and treatment, double-blind treatment design, and outcomes assessment using specific criteria over set periods. In this way, the issue of high-dose PPIs can be explored, and the effect of histamine2 receptor antagonists can be reexamined," Chih-Hung Wang and colleagues write.

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