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Pre-Endoscopic Intravenous Proton Pump Inhibitors for Emergency Department Patients with Upper Gastrointestinal Bleeds: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines

Last updated: February 5, 2016
Project Number: RC0740-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of intravenous proton pump inhibitors initiated before endoscopy in patients with upper gastrointestinal bleeds presenting to the emergency department?
  2. What is the comparative clinical effectiveness of continuous versus intermittent dosing of intravenous proton pump inhibitors initiated before endoscopy in patients with upper gastrointestinal bleeds presenting to the emergency department?
  3. What is the cost-effectiveness of intravenous proton pump inhibitors initiated before endoscopy in patients with upper gastrointestinal bleeds presenting to the emergency department?
  4. What are the evidence-based guidelines regarding the use of proton pump inhibitors before endoscopy in patients with upper gastrointestinal bleeds?

Key Message

One observational study on patients with upper gastrointestinal bleeding who received either proton pump inhibitor infusion or saline infusion before endoscopy showed that overall there were no statistically significant differences between the two modalities with respect to endoscopic signs of bleeding, recurrent bleeding, emergency surgery, or mortality.No relevant studies, on the comparative clinical effectiveness of continuous versus intermittent dosing of intravenous proton pump inhibitors initiated before endoscopy in patients with upper gastrointestinal bleeds presenting to the emergency department, were identified. No relevant studies, on the cost-effectiveness of intravenous proton pump inhibitors initiated before endoscopy in patients with upper gastrointestinal bleeds presenting to the emergency department, were identified.Recommendations regarding the use of proton pump inhibitors before endoscopy in patients with upper gastrointestinal bleeding were inconsistent. Two guidelines recommended pre-endoscopic PPI, one guideline recommended pre-endoscopic PPI in case of delayed endoscopy and one guideline did not recommend pre-endoscopic PPI.