Proton Pump Inhibitors versus Histamine-2-Receptor Antagonists for the Management of Iatrogenic Gastric Ulcer after Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection: A Meta-Analysis of Randomized Trials

Abstract

Background/Aims: Both proton pump inhibitor (PPI) and histamine-2-receptor antagonist (H₂RA) are considered to be effective for the treatment of iatrogenic gastric ulcer after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). We aimed to systematically evaluate the evidence comparing PPI and H₂RA for iatrogenic ulcer. Methods: Data from PubMed, Cochrane Library and Google Scholar were searched to identify eligible randomized trials. Outcome measures were delayed bleeding, epigastric pain and ulcer healing. Results: Six full-text studies were identified including a total of 522 patients. Pooled data suggested a significantly lower bleeding rate in the PPI group than in the H₂RA group (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.25-0.95). Subgroup analysis showed PPI was more effective in the prevention of bleeding than H₂RA for ESD-induced ulcer (OR 0.41, 95% CI 0.20-0.85) and 8-week duration of medication (OR 0.36, 95% CI 0.17-0.76). There were no differences in the incidence of epigastric pain (OR 0.90, 95% CI 0.53-1.51) and ulcer healing rate after endoscopic therapies between both groups. Conclusion: This meta-analysis shows PPI is superior to H₂RA for the prevention of delayed bleeding without different effectiveness in the reduction of epigastric pain and in the promotion of ulcer healing after EMR or ESD.

Endoscopic Submucosal Dissection for Early Gastric Cancer in a Patient with Myelodysplastic Syndrome

“…10,11 In this case, the patient was diagnosed with MDS, and the patient's platelet count was 21,000/mm 3 on the day of the ESD, but the transfusion of platelet concentrates enabled us to perform the procedure without bleeding. PPI administration also might have contributed to the prevention of post-ESD bleeding.…”

Half-Dose Rabeprazole Has an Equal Efficacy to Standard-Dose Rabeprazole on Endoscopic Submucosal Dissection-Induced Ulcer

“…These discrepancies may be attributed to the type and dosage of drug used, follow-up duration, or sample size. Recently, a metaanalysis revealed that PPIs are superior to H 2 RAs for the prevention of delayed bleeding without significant changes in symptom resolution or ulcer healing after EMR or ESD [23]. PPIs have been used widely because they are more effective at elevating the intragastric pH than H 2 RAs.…”

Endoscopic submucosal dissection: Sociedad Española de Endoscopia Digestiva (SEED) clinical guideline

“…In this setting, an 8-week treatment was found to be more effective than 4-week treatment. However, ulcer healing rate at 4 or 8 weeks of treatment seem to be equivalent (103). Recently, several randomized controlled trials compared the combination of PPI and mucosal protective agents (being the most promising rebamipide) with PPI monotherapy in the healing of iatrogenic ulcer after ESD.…”