Efficacy of esomeprazole <i>versus</i> omeprazole in the treatment of non-variceal gastrointestinal bleeding: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHU Jieyun , LUO Yifeng , LI Bocheng , WANG Xiaoling ,  ZHANG Jianfeng

Department of Emergency, the Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, P.R.China;

Corresponding author：

ZHANG Jianfeng, Email: zhangjianfeng930@163.com

Keywords：

Esomeprazole; Omeprazole; Gastrointestinal bleeding; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201902047

Video：

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Objectives To systematically review the efficacy and safety of esomeprazole versus omeprazole in the treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB).Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of esomeprazole versus omeprazole in the treatment of ANVUGIB from inception to January, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 17 RCTs involving 2 086 patients were included. The results of meta-analysis showed that, the total effective rate of esomeprazole group was higher than omeprazole group (RR=1.09, 95%CI 1.04 to 1.14, P=0.000 6), the incidence of adverse reactions was lower than omeprazole group (OR=0.27, 95%CI 0.18 to 0.40, P<0.000 01), the average hemostasis time was shorter than omeprazole group (MD=−0.64, 95%CI −0.94 to −0.34, P<0.0001), and the difference were statistically significant.Conclusions Current evidence shows that in the treatment of ANVUGIB, esomeprazole has rapid hemostasis, significant effect and fewer adverse reactions, which is worthy of wide application and promotion. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

Citation： ZHU Jieyun, LUO Yifeng, LI Bocheng, WANG Xiaoling, ZHANG Jianfeng. Efficacy of esomeprazole versus omeprazole in the treatment of non-variceal gastrointestinal bleeding: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(8): 939-945. doi: 10.7507/1672-2531.201902047 Copy

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2.	Lau JY, Sung J, Hill C, et al. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion, 2011, 84(2): 102-113.
3.	杨丽芳, 李伟珍, 林玉燕, 等. 埃索美拉唑针剂治疗非静脉曲张性上消化道出血的疗效观察. 今日药学, 2017, 27(1): 33-36.
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12.	李改芹, 李福康, 李晓沛. 注射用埃索美拉唑治疗消化性溃疡大出血的疗效分析. 社区医学杂志, 2012, 10(4): 11-13.
13.	刘红英. 埃索美拉唑镁治疗消化性溃疡出血的临床疗效观察. 中外医学研究, 2012, 10(13): 14-15.
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15.	孟莹, 梁晓梅, 周巧直, 等. 埃索美拉唑静脉滴注治疗非静脉曲张性上消化道出血的疗效观察. 中国医院用药评价与分析, 2008, 8(11): 851-853.
16.	王承志, 左旭政. 埃索美拉唑治疗应激性溃疡合并出血的疗效观察. 医学临床研究, 2011, 28(11): 2202-2203.
17.	严聪. 耐信治疗消化性溃疡合并出血的临床效果观察. 吉林医学, 2015, (18): 4017-4018.
18.	衣秀岩. 埃索美拉唑针剂和奥美拉唑针剂治疗上消化道溃疡出血的疗效对照研究. 内蒙古医学杂志, 2017, 49(3): 333-335.
19.	尹凤阁. 埃索美拉唑治疗消化性溃疡大出血的临床研究. 北方药学, 2017, 14(3): 18-19.
20.	余关顺. 埃索美拉唑治疗急性非静脉曲张性上消化道出血的临床观察. 中国当代医药, 2011, 18(16): 77, 93.
21.	赵龙, 李丽, 陈辉, 等. 国产艾司奥美拉唑针剂对非食管静脉曲张出血的疗效分析. 世界临床医学, 2017, 11(22): 88, 90.
22.	《中华内科杂志》编辑部中华医学会消化内镜学分会. 急性非静脉曲张性上消化道出血诊治指南(2015年, 南昌). 中华内科杂志, 2016, 55(2): 164-168.
23.	Klein A, Gralnek IA. Acute, nonvariceal upper gastrointestinal bleeding. Cur Opin in Crit care, 2015, 21(2): 154-162.
24.	Jiang M, Chen P, Gao Q. Systematic review and net-work meta-analysis of upper gastrointestinal hemorrhage interventions. Cell Physiol Biochem, 2016, 39(6): 2477-2491.
25.	Bai Y, Chen DF, Wang RQ, et al. Intravenous esomeprazole for prevention of peptic ulcer rebleeding: a randomized trial in Chinese patients. Adv Ther, 2015, 32(11): 1160-1176.
26.	Lanas A, Polo-Tomas M, García-Rodríguez LA, et al. Effect of proton pump inhibitors on the outcomes of peptic ulcer bleeding: comparison of event rates in routine clinical practice and a clinical trial. Scand J Gastroenterol, 2013, 48(3): 285-294.

1. Alzoubaidi D, Lovat LB, Haidry R. Management of non-variceal upper gastrointestinal bleeding: where are we in 2018? Frontline Gastroenterol, 2019, 10(1): 34-42.
2. Lau JY, Sung J, Hill C, et al. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion, 2011, 84(2): 102-113.
3. 杨丽芳, 李伟珍, 林玉燕, 等. 埃索美拉唑针剂治疗非静脉曲张性上消化道出血的疗效观察. 今日药学, 2017, 27(1): 33-36.
4. 钟捷. 埃索美拉唑-奥美拉唑的左旋异构体的药效及药代动力学. 中华消化杂志, 2003, 23(5): 306-307.
5. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
6. 曾凡清. 埃索美拉唑与奥美拉唑治疗溃疡出血疗效比较. 中外医疗, 2013, 32(27): 107, 110.
7. 陈炽昌, 刘炽彬, 黄静. 埃索美拉唑针剂治疗消化性溃疡并出血的临床疗效探讨. 现代诊断与治疗, 2017, 28(21): 3953-3954.
8. 陈嘉韦. 艾司奥美拉唑钠与奥美拉唑钠治疗急性上消化道出血的疗效及安全性比较. 临床研究, 2019, 27(1): 85-87.
9. 陈武, 董媛, 王晓平. 埃索美拉唑持续泵入治疗急性上消化道大出血疗效观察. 中国医药科学, 2014, (19): 59-61.
10. 高丹, 望燕. 静脉滴注埃索美拉唑钠治疗急性非静脉曲张性上消化道出血的临床疗效及安全性评价. 临床急诊杂志, 2016, 17(3): 233-235.
11. 李朝芬. 上消化道出血患者采取" 埃索美拉唑(耐信)”与" 奥美拉唑”治疗的临床疗效探讨. 中西医结合心血管病电子杂志, 2017, 5(31): 155-156.
12. 李改芹, 李福康, 李晓沛. 注射用埃索美拉唑治疗消化性溃疡大出血的疗效分析. 社区医学杂志, 2012, 10(4): 11-13.
13. 刘红英. 埃索美拉唑镁治疗消化性溃疡出血的临床疗效观察. 中外医学研究, 2012, 10(13): 14-15.
14. 刘有东. 用埃索美拉唑钠治疗急性非静脉曲张性上消化道出血的效果探究. 当代医药论丛, 2018, 16(9): 94-96.
15. 孟莹, 梁晓梅, 周巧直, 等. 埃索美拉唑静脉滴注治疗非静脉曲张性上消化道出血的疗效观察. 中国医院用药评价与分析, 2008, 8(11): 851-853.
16. 王承志, 左旭政. 埃索美拉唑治疗应激性溃疡合并出血的疗效观察. 医学临床研究, 2011, 28(11): 2202-2203.
17. 严聪. 耐信治疗消化性溃疡合并出血的临床效果观察. 吉林医学, 2015, (18): 4017-4018.
18. 衣秀岩. 埃索美拉唑针剂和奥美拉唑针剂治疗上消化道溃疡出血的疗效对照研究. 内蒙古医学杂志, 2017, 49(3): 333-335.
19. 尹凤阁. 埃索美拉唑治疗消化性溃疡大出血的临床研究. 北方药学, 2017, 14(3): 18-19.
20. 余关顺. 埃索美拉唑治疗急性非静脉曲张性上消化道出血的临床观察. 中国当代医药, 2011, 18(16): 77, 93.
21. 赵龙, 李丽, 陈辉, 等. 国产艾司奥美拉唑针剂对非食管静脉曲张出血的疗效分析. 世界临床医学, 2017, 11(22): 88, 90.
22. 《中华内科杂志》编辑部中华医学会消化内镜学分会. 急性非静脉曲张性上消化道出血诊治指南(2015年, 南昌). 中华内科杂志, 2016, 55(2): 164-168.
23. Klein A, Gralnek IA. Acute, nonvariceal upper gastrointestinal bleeding. Cur Opin in Crit care, 2015, 21(2): 154-162.
24. Jiang M, Chen P, Gao Q. Systematic review and net-work meta-analysis of upper gastrointestinal hemorrhage interventions. Cell Physiol Biochem, 2016, 39(6): 2477-2491.
25. Bai Y, Chen DF, Wang RQ, et al. Intravenous esomeprazole for prevention of peptic ulcer rebleeding: a randomized trial in Chinese patients. Adv Ther, 2015, 32(11): 1160-1176.
26. Lanas A, Polo-Tomas M, García-Rodríguez LA, et al. Effect of proton pump inhibitors on the outcomes of peptic ulcer bleeding: comparison of event rates in routine clinical practice and a clinical trial. Scand J Gastroenterol, 2013, 48(3): 285-294.

Chinese Journal of Evidence-Based Medicine

Efficacy of esomeprazole versus omeprazole in the treatment of non-variceal gastrointestinal bleeding: a meta-analysis

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