Missed Opportunities in the Trial on Proton-Pump Inhibitor Therapy in Bleeding Peptic Ulcers
Authors: Alejandro Piscoya
Journal: Annals of Internal Medicine (2009)

Letters20 October 2009Missed Opportunities in the Trial on Proton-Pump Inhibitor Therapy in Bleeding Peptic UlcersAlejandro Piscoya, MDAlejandro Piscoya, MDFrom Universidad Peruana de Ciencias Aplicadas, Lima, Peru.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-8-200910200-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read with interest the article by Sung and colleagues (1). However, it's not news that PPI therapy is better than placebo in the treatment of ulcer bleeding. This was assessed more than a decade ago, and even some cost-effectiveness studies (2) support this conclusion. In addition, some studies (3–5) used low-dose PPI therapy and found no differences between high or low doses of PPI therapy.Is it ethical to continue to use placebo as a control when enough evidence exists that PPI therapy should be used in peptic ulcer bleeding? Perhaps the only new studies on ...References1. Sung JJ, Barkun A, Kuipers EJ, Mössner J, Jensen DM, Stuart R, et al; Peptic Ulcer Bleed Study Group. Intravenous esomeprazole for prevention of recurrent peptic ulcer bleeding: a randomized trial. Ann Intern Med. 2009;150:455-64. [PMID: 19221370] LinkGoogle Scholar2. van Zanten SV. Cost-effectiveness of intravenous proton pump inhibitors in high-risk bleeders. Can J Gastroenterol. 2004;18:749-50. [PMID: 15605141] CrossrefMedlineGoogle Scholar3. Udd M, Miettinen P, Palmu A, Heikkinen M, Janatuinen E, Pasanen P, et al. Regular-dose versus high-dose omeprazole in peptic ulcer bleeding: a prospective randomized double-blind study. Scand J Gastroenterol. 2001;36:1332-8. [PMID: 11761026] CrossrefMedlineGoogle Scholar4. Hung WK, Li VK, Chung CK, Ying MW, Loo CK, Liu CK, et al. Randomized trial comparing pantoprazole infusion, bolus and no treatment on gastric pH and recurrent bleeding in peptic ulcers. ANZ J Surg. 2007;77:677-81. [PMID: 17635283] CrossrefMedlineGoogle Scholar5. Andriulli A, Loperfido S, Focareta R, Leo P, Fornari F, Garripoli A, et al. High- versus low-dose proton pump inhibitors after endoscopic hemostasis in patients with peptic ulcer bleeding: a multicentre, randomized study. Am J Gastroenterol. 2008;103:3011-8. [PMID: 19086953] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Universidad Peruana de Ciencias Aplicadas, Lima, Peru.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIntravenous Esomeprazole for Prevention of Recurrent Peptic Ulcer Bleeding Joseph J.Y. Sung , Alan Barkun , Ernst J. Kuipers , Joachim Mössner , Dennis M. Jensen , Robert Stuart , James Y. Lau , Henrik Ahlbom , Jan Kilhamn , Tore Lind , and Missed Opportunities in the Trial on Proton-Pump Inhibitor Therapy in Bleeding Peptic Ulcers Joseph J.Y. Sung , Alan Barkun , and Ernst J. Kuipers Missed Opportunities in the Trial on Proton-Pump Inhibitor Therapy in Bleeding Peptic Ulcers Vivian Yih and Aaron Tejani Missed Opportunities in the Trial on Proton-Pump Inhibitor Therapy in Bleeding Peptic Ulcers Hwai-Jeng Lin and Yao-Chun Hsu Metrics 20 October 2009Volume 151, Issue 8Page: 589-590KeywordsConflicts of interestHemorrhagePeptic ulcersUlcers ePublished: 20 October 2009 Issue Published: 20 October 2009 CopyrightCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...