Continuous Infusion Versus Intermittent Bolus Proton Pump Inhibitor Therapy Following Endoscopic Hemostasis for Bleeding Peptic Ulcers: A Systematic Review and Meta-Analysis
In brief
Continuous proton pump inhibitor infusion did not significantly cut rebleeding in 1,621 patients
Across 11 trials involving 1,621 patients, continuous intravenous proton pump inhibitor infusion showed no clear rebleeding advantage over intermittent doses; surgery, mortality, transfusions, and hospital stay also showed little or no difference. Evidence for rebleeding, surgery, and mortality was low or very low certainty, so the findings do not establish equivalence or rule out meaningful benefit or harm.
- Journal
- Journal of clinical medicine (Q1)
- Published
- 8 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- José Luis Muñoz-Carrillo, Gustavo Bastién-Martínez, Edrei Lopez-Hernandez, Vladimir Guerrero-Toralva, Frida Sofia Ontiveros-Ramos, Alejandra Vargas-Flores, et al.
- PMID
- 42882202
- DOI
- 10.3390/jcm15197743
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 18 October 2026): Continuous PPI infusion not superior after ulcer hemostasis
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.