Rodriguez E, et al. – Among trials evaluating acid suppressive medications in acute nonvariceal upper gastrointestinal bleeding (ANVGIB), the authors conducted a systematic review and network meta–analysis for the endpoints of the risk of rebleeding, the length of stay (LOS), surgery (ROS), mortality, and total units of blood transfused (UBT). For most outcomes, scheduled intravenous (IV) proton pump inhibitors (PPIs) were as effective as IV PPI drip. For LOS and UBT, oral PPIs were comparable to scheduled IV and superior to IV PPI drip for ROS. Conclusions ought to be tempered by low–frequency endpoints luke ROS, but questioned the need for IV PPI drip in ANVGIB.

• The authors identified 39 studies using IV PPI drip, IV scheduled PPI, oral PPI, H2-receptor antagonists, and placebo.
• They used network meta-analysis for indirect comparisons and Bayesian Markov Chain Monte Carlo methods for calculation of probability superiority.

• The authors observed no difference between IV PPI drip and scheduled IV PPI for mortality (relative risk=1.11; 95% credibility interval, 0.56-2.21), LOS (0.04, -0.49 to 0.44), ROS (1.27, 0.64-2.35) and risk of rebleeding within 72 hours, 1 week, and 1 month [(0.98, 0.48-1.95), (0.59, 0.13-2.03), (0.82, 0.28-2.16)].
• They found that oral PPIs were as effective as IV scheduled PPIs and IV PPI drip for LOS (0.22, -0.61 to 0.79 and 0.16, -0.56 to 0.80) and UBT (-0.25, -1.23 to 0.65 and -0.06, -0.71 to 0.65) and superior to IV PPI drip for ROS (0.30, 0.10 to 0.78).