No abstract

In addition, the conclusions of the trial by Andriulli et al 3 have been challenged because of a number of recognized methodological limitations. 4 These included a systematic bias in the ascertainment of rebleeding in the high-dose IV PPI group, questions raised about the adequacy of blinding, confounding attributable to selective use of second-look endoscopy (with possible betweengroup imbalances), and a lack of statistical adjustment for each participating center to account for unmeasured variations in supportive and endoscopic therapy.Finally, and perhaps most importantly, the observed effect size, the total number of patients included in the meta-analysis, and the resulting confidence interval are insufficient to claim that low-dose IV PPI regimens are equivalent to high-dose IV PPI.Bleeding from high-risk ulcers carries considerable morbidity and mortality, and using a less-effective therapy may place patients at risk for adverse outcomes. Although low-dose IV PPI regimens may well be as effective as the high-dose infusion alternative, more definitive evidence demonstrating equivalence is necessary before recommending its use. It currently seems reasonable to keep using a high-dose PPI infusion of 80-mg bolus followed by 8 mg/h for 3 days following successful endoscopic therapy, as endorsed by the recently published international consensus recommendations on nonvariceal upper gastrointestinal tract bleeding. 5