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

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.	楊麗芳, 李偉珍, 林玉燕, 等. 埃索美拉唑針劑治療非靜脈曲張性上消化道出血的療效觀察. 今日藥學, 2017, 27(1): 33-36.
4.	鐘捷. 埃索美拉唑-奧美拉唑的左旋異構體的藥效及藥代動力學. 中華消化雜志, 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. 埃索美拉唑與奧美拉唑治療潰瘍出血療效比較. 中外醫療, 2013, 32(27): 107, 110.
7.	陳熾昌, 劉熾彬, 黃靜. 埃索美拉唑針劑治療消化性潰瘍并出血的臨床療效探討. 現代診斷與治療, 2017, 28(21): 3953-3954.
8.	陳嘉韋. 艾司奧美拉唑鈉與奧美拉唑鈉治療急性上消化道出血的療效及安全性比較. 臨床研究, 2019, 27(1): 85-87.
9.	陳武, 董媛, 王曉平. 埃索美拉唑持續泵入治療急性上消化道大出血療效觀察. 中國醫藥科學, 2014, (19): 59-61.
10.	高丹, 望燕. 靜脈滴注埃索美拉唑鈉治療急性非靜脈曲張性上消化道出血的臨床療效及安全性評價. 臨床急診雜志, 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)”與" 奧美拉唑”治療的臨床療效探討. 中西醫結合心血管病電子雜志, 2017, 5(31): 155-156.
12.	李改芹, 李福康, 李曉沛. 注射用埃索美拉唑治療消化性潰瘍大出血的療效分析. 社區醫學雜志, 2012, 10(4): 11-13.
13.	劉紅英. 埃索美拉唑鎂治療消化性潰瘍出血的臨床療效觀察. 中外醫學研究, 2012, 10(13): 14-15.
14.	劉有東. 用埃索美拉唑鈉治療急性非靜脈曲張性上消化道出血的效果探究. 當代醫藥論叢, 2018, 16(9): 94-96.
15.	孟瑩, 梁曉梅, 周巧直, 等. 埃索美拉唑靜脈滴注治療非靜脈曲張性上消化道出血的療效觀察. 中國醫院用藥評價與分析, 2008, 8(11): 851-853.
16.	王承志, 左旭政. 埃索美拉唑治療應激性潰瘍合并出血的療效觀察. 醫學臨床研究, 2011, 28(11): 2202-2203.
17.	嚴聰. 耐信治療消化性潰瘍合并出血的臨床效果觀察. 吉林醫學, 2015, (18): 4017-4018.
18.	衣秀巖. 埃索美拉唑針劑和奧美拉唑針劑治療上消化道潰瘍出血的療效對照研究. 內蒙古醫學雜志, 2017, 49(3): 333-335.
19.	尹鳳閣. 埃索美拉唑治療消化性潰瘍大出血的臨床研究. 北方藥學, 2017, 14(3): 18-19.
20.	余關順. 埃索美拉唑治療急性非靜脈曲張性上消化道出血的臨床觀察. 中國當代醫藥, 2011, 18(16): 77, 93.
21.	趙龍, 李麗, 陳輝, 等. 國產艾司奧美拉唑針劑對非食管靜脈曲張出血的療效分析. 世界臨床醫學, 2017, 11(22): 88, 90.
22.	《中華內科雜志》編輯部中華醫學會消化內鏡學分會. 急性非靜脈曲張性上消化道出血診治指南(2015年, 南昌). 中華內科雜志, 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. 楊麗芳, 李偉珍, 林玉燕, 等. 埃索美拉唑針劑治療非靜脈曲張性上消化道出血的療效觀察. 今日藥學, 2017, 27(1): 33-36.
4. 鐘捷. 埃索美拉唑-奧美拉唑的左旋異構體的藥效及藥代動力學. 中華消化雜志, 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. 埃索美拉唑與奧美拉唑治療潰瘍出血療效比較. 中外醫療, 2013, 32(27): 107, 110.
7. 陳熾昌, 劉熾彬, 黃靜. 埃索美拉唑針劑治療消化性潰瘍并出血的臨床療效探討. 現代診斷與治療, 2017, 28(21): 3953-3954.
8. 陳嘉韋. 艾司奧美拉唑鈉與奧美拉唑鈉治療急性上消化道出血的療效及安全性比較. 臨床研究, 2019, 27(1): 85-87.
9. 陳武, 董媛, 王曉平. 埃索美拉唑持續泵入治療急性上消化道大出血療效觀察. 中國醫藥科學, 2014, (19): 59-61.
10. 高丹, 望燕. 靜脈滴注埃索美拉唑鈉治療急性非靜脈曲張性上消化道出血的臨床療效及安全性評價. 臨床急診雜志, 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)”與" 奧美拉唑”治療的臨床療效探討. 中西醫結合心血管病電子雜志, 2017, 5(31): 155-156.
12. 李改芹, 李福康, 李曉沛. 注射用埃索美拉唑治療消化性潰瘍大出血的療效分析. 社區醫學雜志, 2012, 10(4): 11-13.
13. 劉紅英. 埃索美拉唑鎂治療消化性潰瘍出血的臨床療效觀察. 中外醫學研究, 2012, 10(13): 14-15.
14. 劉有東. 用埃索美拉唑鈉治療急性非靜脈曲張性上消化道出血的效果探究. 當代醫藥論叢, 2018, 16(9): 94-96.
15. 孟瑩, 梁曉梅, 周巧直, 等. 埃索美拉唑靜脈滴注治療非靜脈曲張性上消化道出血的療效觀察. 中國醫院用藥評價與分析, 2008, 8(11): 851-853.
16. 王承志, 左旭政. 埃索美拉唑治療應激性潰瘍合并出血的療效觀察. 醫學臨床研究, 2011, 28(11): 2202-2203.
17. 嚴聰. 耐信治療消化性潰瘍合并出血的臨床效果觀察. 吉林醫學, 2015, (18): 4017-4018.
18. 衣秀巖. 埃索美拉唑針劑和奧美拉唑針劑治療上消化道潰瘍出血的療效對照研究. 內蒙古醫學雜志, 2017, 49(3): 333-335.
19. 尹鳳閣. 埃索美拉唑治療消化性潰瘍大出血的臨床研究. 北方藥學, 2017, 14(3): 18-19.
20. 余關順. 埃索美拉唑治療急性非靜脈曲張性上消化道出血的臨床觀察. 中國當代醫藥, 2011, 18(16): 77, 93.
21. 趙龍, 李麗, 陳輝, 等. 國產艾司奧美拉唑針劑對非食管靜脈曲張出血的療效分析. 世界臨床醫學, 2017, 11(22): 88, 90.
22. 《中華內科雜志》編輯部中華醫學會消化內鏡學分會. 急性非靜脈曲張性上消化道出血診治指南(2015年, 南昌). 中華內科雜志, 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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