S1399 Potassium-Competitive Acid Blockers vs Proton-Pump Inhibitors in the Prevention of Peptic Ulcer Re-Bleeding After Endoscopic Hemostasis: A Systematic Review and Meta-Analysis

Introduction: Vonoprazan, a new oral potassium-competitive acid blocker (PCAB) with strong and sustained acid-inhibitory activity, has shown promise in terms of superior acid suppression when compared to Proton-pump inhibitors (PPIs). This systematic review and meta-analysis aims to evaluate the efficacy of PCABs compared to PPIs in preventing re-bleeding in high-risk peptic ulcer patients after successful endoscopic hemostasis. Methods: We conducted a comprehensive search for studies examining the efficacy of PCABs compared to PPIs in preventing re-bleeding in high-risk peptic ulcer patients after successful endoscopic hemostasis. A medical librarian conducted electronic searches using Medline, Embase, Web of Science, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov, from inception until March 25, 2025. The primary outcome of interest was peptic ulcer re-bleeding rate. Secondary outcomes included all-cause mortality and hospital length of stay. Pooled risk ratios (RR) and mean difference (MD) with the corresponding 95% confidence intervals (CIs) were calculated. Results: Three studies (2 randomized control trials and one propensity-matched retrospective cohort study) with 54,410 patients receiving endoscopic hemostasis for peptic ulcer bleeding (27,205 patients in the PCAB group and 27,205 patients in the PPI group) were included in the meta-analysis. Two of the included studies collected data from Thailand and one from Japan. All 3 studies were published in 2024. The mean age of included participants was 71 ± 1.83 years. There was no significant difference in rebleeding rates between patients receiving PPIs and PCABs (RR: 0.612, 95% CI: 0.343-1.094, P = 0.419, I2 = 54.6%). In our secondary analysis we observed a statistically significant reduction in length of hospital stay in the PCAB group when compared to the PPI group (MD: -0.443, 95% CI: -0.715 - -0.172), P = 0.001, I2 = 0), and no significant difference in all-cause mortality between both groups (RR: 0.905, 95% CI: 0.79-1.04, P = 0.155, I2 = 0). Conclusion: Our study demonstrates comparable efficacy of PPIs and PCABs (Vonoprazan) in preventing rebleeding in patients with high-risk peptic ulcers after successful endoscopic hemostasis. Considering the higher cost of Vonoprazan, PPIs remain the preferred option for acid suppression in these patients given the ease of access and the consequential reduction in healthcare costs. However, randomized studies with larger sample sizes are needed to validate these findings.