Continuous Infusion Versus Intermittent Bolus Proton Pump Inhibitor Therapy Following Endoscopic Hemostasis for Bleeding Peptic Ulcers: A Systematic Review and Meta-Analysis
8 affiliations
- 1Laboratorio de Inmunología, Centro Universitario de los Lagos, Universidad de Guadalajara, Enrique Díaz de León 1144, Paseos de La Montaña, Lagos de Moreno 47463, Jalisco, Mexico
- 2Centro de Investigación e Innovación Global University (CIIGU), Av Independencia 2134, Trojes de Alonso, Aguascalientes 20116, Aguascalientes, Mexico
- 3Especialidad en Medicina Interna, Universidad Autónoma de Aguascalientes, Av Universidad 940, Ciudad Universitaria, Aguascalientes 20100, Aguascalientes, Mexico
- 4Facultad de Medicina Campus Xalapa, Unidad de Ciencias de la Salud, Universidad Veracruzana, Médicos y Odontólogos S/N, Unidad del Bosque, Xalapa de Enriquez 91010, Veracruz, Mexico
- 5Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juarez, Plutarco Elías Calles 1210, Fraccionamiento Fovissste Chamizal, Ciudad Juárez 32310, Chihuahua, Mexico
- 6Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Av Guillermo Massieu Helguera 239, La Purísima Ticoman, Gustavo A. Madero, Ciudad de México 0732, Mexico
- 7Licenciatura en Nutrición, Unidad Académica de Enfermería, Universidad Autónoma de Zacatecas, Carretera Zacatecas-Guadalajara Km. 6, Ejido La Escondida, Zacatecas 98160, Zacatecas, Mexico
- 8Facultad de Medicina, Universidad El Bosque, Bogotá 110121, PC, Colombia
Abstract
Background/Objectives: Continuous high-dose intravenous proton pump inhibitor (PPI) infusion is commonly used following endoscopic hemostasis for bleeding peptic ulcers, despite uncertainty regarding its clinical advantage over intermittent administration. This systematic review and meta-analysis evaluated whether continuous infusion improves clinically relevant outcomes compared with intermittent intravenous bolus therapy. Methods: A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, and Embase was conducted from inception through to 29 June 2026 to identify randomized controlled trials. Effect estimates were pooled using random-effects models with restricted maximum-likelihood estimation and Hartung–Knapp adjustment. Risk of bias was assessed using RoB 2 and certainty of evidence using GRADE. The protocol was retrospectively registered on OSF. Results: Twelve randomized controlled trials involving 1726 participants were included. Across 11 trials (1621 participants), the pooled estimate did not demonstrate a statistically significant reduction in overall rebleeding with continuous infusion compared with intermittent bolus therapy (RR 0.93, 95% CI 0.65–1.35; I2 = 1.4%). Likewise, the pooled estimates did not demonstrate superiority of continuous infusion for rebleeding within 24 h (RR 0.70, 95% CI 0.09–5.64), rebleeding within 7 days (RR 1.07, 95% CI 0.66–1.72), surgery (RR 1.42, 95% CI 0.80–2.53), or mortality (RR 1.76, 95% CI 0.90–3.44). Moderate-certainty evidence indicated little or no clinically important difference in blood units transfused or hospital stay. Certainty was very low for rebleeding outcomes and low for surgery and mortality. Conclusions: Continuous intravenous PPI infusion was not shown to be superior to intermittent intravenous bolus therapy following successful endoscopic hemostasis. However, the very low- to low-certainty evidence for rebleeding, surgery, and mortality establishes neither equivalence nor noninferiority and does not exclude clinically important benefit or harm. The available trials do not identify the optimal intermittent dose or dosing frequency.
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BibTeX
@article{munozcarrillo2026continuous,
title = {{Continuous Infusion Versus Intermittent Bolus Proton Pump Inhibitor Therapy Following Endoscopic Hemostasis for Bleeding Peptic Ulcers: A Systematic Review and Meta-Analysis}},
author = {José Luis Muñoz-Carrillo and Gustavo Bastién-Martínez and Edrei Lopez-Hernandez and Vladimir Guerrero-Toralva and Frida Sofia Ontiveros-Ramos and Alejandra Vargas-Flores and Adair Zabdiel Cortés-Gutiérrez and Francisca Chávez-Ruvalcaba and Natalie Rodríguez-Cortés and Oscar Gutiérrez-Coronado},
journal = {Journal of clinical medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15197743},
url = {https://europepmc.org/article/PMC/PMC13666069},
note = {CC BY},
}
RIS
TY - JOUR
TI - Continuous Infusion Versus Intermittent Bolus Proton Pump Inhibitor Therapy Following Endoscopic Hemostasis for Bleeding Peptic Ulcers: A Systematic Review and Meta-Analysis
AU - José Luis Muñoz-Carrillo
AU - Gustavo Bastién-Martínez
AU - Edrei Lopez-Hernandez
AU - Vladimir Guerrero-Toralva
AU - Frida Sofia Ontiveros-Ramos
AU - Alejandra Vargas-Flores
AU - Adair Zabdiel Cortés-Gutiérrez
AU - Francisca Chávez-Ruvalcaba
AU - Natalie Rodríguez-Cortés
AU - Oscar Gutiérrez-Coronado
PY - 2026
DA - 2026/10/01
JO - Journal of clinical medicine
DO - 10.3390/jcm15197743
UR - https://europepmc.org/article/PMC/PMC13666069
AB - Background/Objectives: Continuous high-dose intravenous proton pump inhibitor (PPI) infusion is commonly used following endoscopic hemostasis for bleeding peptic ulcers, despite uncertainty regarding its clinical advantage over intermittent administration. This systematic review and meta-analysis evaluated whether continuous infusion improves clinically relevant outcomes compared with intermittent intravenous bolus therapy. Methods: A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, and Embase was conducted from inception through to 29 June 2026 to identify randomized controlled trials. Effect estimates were pooled using random-effects models with restricted maximum-likelihood estimation and Hartung–Knapp adjustment. Risk of bias was assessed using RoB 2 and certainty of evidence using GRADE. The protocol was retrospectively registered on OSF. Results: Twelve randomized controlled trials involving 1726 participants were included. Across 11 trials (1621 participants), the pooled estimate did not demonstrate a statistically significant reduction in overall rebleeding with continuous infusion compared with intermittent bolus therapy (RR 0.93, 95% CI 0.65–1.35; I2 = 1.4%). Likewise, the pooled estimates did not demonstrate superiority of continuous infusion for rebleeding within 24 h (RR 0.70, 95% CI 0.09–5.64), rebleeding within 7 days (RR 1.07, 95% CI 0.66–1.72), surgery (RR 1.42, 95% CI 0.80–2.53), or mortality (RR 1.76, 95% CI 0.90–3.44). Moderate-certainty evidence indicated little or no clinically important difference in blood units transfused or hospital stay. Certainty was very low for rebleeding outcomes and low for surgery and mortality. Conclusions: Continuous intravenous PPI infusion was not shown to be superior to intermittent intravenous bolus therapy following successful endoscopic hemostasis. However, the very low- to low-certainty evidence for rebleeding, surgery, and mortality establishes neither equivalence nor noninferiority and does not exclude clinically important benefit or harm. The available trials do not identify the optimal intermittent dose or dosing frequency.
SN - 2077-0383
ER -