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Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38356.641134.8F (Published 10 March 2005) Cite this as: BMJ 2005;330:568

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EDITOR: Many of Dr Fiddian-Green’s provocative comments are unrelated to our work. Objective measures of shock or its metabolic consequences were not available to us from the published trials we reviewed. We will not reiterate here our views on the mortality data - but we invite Dr Fiddian-Green to read our response to Dr Penston. We considered only “all- cause” mortality and agree fully with Dr Fiddian-Green’s presumption that not all the deaths that occur following ulcer bleeding are directly related to the actual bleed. We have made no statement or study of any possible long-term metabolic consequences of PPI therapy. All we would state in mitigation is that these drugs have been intensively and extensively studied and there have been millions of patient-years of exposure. Had some relatively – or extremely – infrequent but unusual adverse event been encountered, it is likely to have been detected even with our admittedly imperfect monitoring systems. We do not recommend the routine use of PPI therapy for patients undergoing general anaesthesia because we are unaware of any evidence from randomised controlled trials to attest to its efficacy, appropriateness or need.

Grigoris I Leontiadis, consultant gastroenterologist, Department of Gastroenterology, University Hospital of North Durham, Durham DH1 5TW

Virender K Sharma, associate professor, Division of Gastroenterology, Mayo Clinic, Scottsdale, AZ 85259, USA

Colin W Howden, professor, Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
c-howden@northwestern.edu

Competing interests: As stated in our original publication

Competing interests: No competing interests

22 March 2005
Colin W Howden
Professor of Medicine, Northwestern University, Chicago, IL, USA
Grigoris I. Leontiadis, Virender K. Sharma, Colin W. Howden
676 N. St. Clair Street, Suite 1400,l Chicago, IL 60611, USA