S1370 Intermittent vs Continuous Proton Pump Inhibitor Therapy for Bleeding Peptic Ulcer: An Updated Systematic Review and Meta-Analysis

Introduction: Gastrointestinal bleeding from peptic ulcers remains a significant clinical challenge, with high rebleeding rates even after endoscopic intervention. Proton pump inhibitors (PPIs) are commonly used to maintain hemostasis by maintaining gastric pH, but the optimal administration method—continuous infusion versus intermittent therapy—remains debated. This meta-analysis compares the efficacy of intermittent versus continuous PPI therapy in preventing rebleeding and other clinical outcomes in patients with bleeding peptic ulcers. Methods: We systematically searched databases including Embase, Scopus, Web of Science, Medline/PubMed, and Cochrane. Primary outcomes were rebleeding rates, mortality, hospital stay duration, and ICU admissions. Quality assessment was conducted using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Risk of Bias Tool (ROB2) for RCTs. Meta-analyses were performed using a random-effects model, and heterogeneity was assessed with the I² statistic. Results: Eighteen studies (n = 3664) were included, spanning multiple countries. Meta-analysis showed no significant difference between intermittent and continuous PPI therapy in terms of rebleeding rates (OR = 1.02; 95% CI = 0.80–1.29; P = 0.88, I² = 20%), mortality (OR = 0.93; 95% CI = 0.56–1.55; P = 0.79, I² = 21%), or the need for surgery (OR = 1.09; 95% CI = 0.71–1.70; P = 0.69, I² = 0%). However, intermittent therapy was associated with significantly lower ICU admissions (OR = 0.29; 95% CI = 0.22–0.40; P < 0.00001, I² = 7%). Conclusion: Intermittent PPI therapy is as effective as continuous infusion in managing bleeding peptic ulcers, with comparable rebleeding, surgery, and mortality outcomes. Intermittent therapy also reduces ICU admission rates, suggesting a viable, cost-effective alternative to continuous infusion. Further research with larger, multi-center trials is needed to confirm these findings across diverse populations and healthcare settings.