Less is more - high dose PPI 對於 rebleeding, surgery, mortality似乎無幫忙

LESS IS MORE
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

Chih-Hung Wang, MD; Matthew Huei-Ming Ma, MD, PhD; Hao-Chang Chou, MD; Zui-Shen Yen, MD, MPH; Chih-Wei Yang, MD; Cheng-Chung Fang, MD; Shyr-Chyr Chen, MD

Arch Intern Med. 2010;170(9):751-758.

Background 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.

High dose PPI也太高dose了, 台大做的考古文章

http://docs.google.com/fileview?id=0B278nGJMQBk7MjE2MDU3YTMtMTMzNi00YWE5LWJiZTYtMDdkY2ZlZjY1ZWVj&hl=en

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early vs late tracheostomy, 早切不會降低死亡率，不會降低VAP，不會降低LOS, wait!

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