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Study flow diagram: review update 03 June 2021

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Figure 1

Study flow diagram: review update 03 June 2021

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Trial sequential analysis (TSA) for outcome mortality
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Figure 4

Trial sequential analysis (TSA) for outcome mortality

Trial sequential analysis (TSA) for outcome rebleeding
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Figure 5

Trial sequential analysis (TSA) for outcome rebleeding

Comparison 1: Main analysis, Outcome 1: Mortality

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Analysis 1.1

Comparison 1: Main analysis, Outcome 1: Mortality

Comparison 1: Main analysis, Outcome 2: Rebleeding

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Analysis 1.2

Comparison 1: Main analysis, Outcome 2: Rebleeding

Comparison 1: Main analysis, Outcome 3: Surgery

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Analysis 1.3

Comparison 1: Main analysis, Outcome 3: Surgery

Comparison 1: Main analysis, Outcome 4: Participants requiring blood transfusion

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Analysis 1.4

Comparison 1: Main analysis, Outcome 4: Participants requiring blood transfusion

Comparison 1: Main analysis, Outcome 5: Proportion of participants with stigmata of recent haemorrhage

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Analysis 1.5

Comparison 1: Main analysis, Outcome 5: Proportion of participants with stigmata of recent haemorrhage

Comparison 1: Main analysis, Outcome 6: Proportion of participants with stigmata of recent haemorrhage plus Lau 2007

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Analysis 1.6

Comparison 1: Main analysis, Outcome 6: Proportion of participants with stigmata of recent haemorrhage plus Lau 2007

Comparison 1: Main analysis, Outcome 7: Proportion of participants with blood in stomach

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Analysis 1.7

Comparison 1: Main analysis, Outcome 7: Proportion of participants with blood in stomach

Comparison 1: Main analysis, Outcome 8: Proportion of participants with active bleeding

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Analysis 1.8

Comparison 1: Main analysis, Outcome 8: Proportion of participants with active bleeding

Comparison 1: Main analysis, Outcome 9: Proportion of participants with active bleeding plus Lau 2007

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Analysis 1.9

Comparison 1: Main analysis, Outcome 9: Proportion of participants with active bleeding plus Lau 2007

Comparison 1: Main analysis, Outcome 10: Endoscopic haemostatic treatment at index endoscopy

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Analysis 1.10

Comparison 1: Main analysis, Outcome 10: Endoscopic haemostatic treatment at index endoscopy

Comparison 2: Subgroup analysis according to risk of bias, Outcome 1: Mortality

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Analysis 2.1

Comparison 2: Subgroup analysis according to risk of bias, Outcome 1: Mortality

Comparison 2: Subgroup analysis according to risk of bias, Outcome 2: Rebleeding

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Analysis 2.2

Comparison 2: Subgroup analysis according to risk of bias, Outcome 2: Rebleeding

Comparison 2: Subgroup analysis according to risk of bias, Outcome 3: Surgery

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Analysis 2.3

Comparison 2: Subgroup analysis according to risk of bias, Outcome 3: Surgery

Comparison 2: Subgroup analysis according to risk of bias, Outcome 4: Proportion of participants with stigmata of recent haemorrhage

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Analysis 2.4

Comparison 2: Subgroup analysis according to risk of bias, Outcome 4: Proportion of participants with stigmata of recent haemorrhage

Comparison 2: Subgroup analysis according to risk of bias, Outcome 5: Endoscopic haemostatic treatment at index endoscopy

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Analysis 2.5

Comparison 2: Subgroup analysis according to risk of bias, Outcome 5: Endoscopic haemostatic treatment at index endoscopy

Comparison 3: Subgroup analysis according to geographic location, Outcome 1: Mortality

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Analysis 3.1

Comparison 3: Subgroup analysis according to geographic location, Outcome 1: Mortality

Comparison 3: Subgroup analysis according to geographic location, Outcome 2: Rebleeding

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Analysis 3.2

Comparison 3: Subgroup analysis according to geographic location, Outcome 2: Rebleeding

Comparison 3: Subgroup analysis according to geographic location, Outcome 3: Surgery

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Analysis 3.3

Comparison 3: Subgroup analysis according to geographic location, Outcome 3: Surgery

Comparison 4: Subgroup analysis according to route of PPI administration, Outcome 1: Mortality

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Analysis 4.1

Comparison 4: Subgroup analysis according to route of PPI administration, Outcome 1: Mortality

Comparison 4: Subgroup analysis according to route of PPI administration, Outcome 2: Rebleeding

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Analysis 4.2

Comparison 4: Subgroup analysis according to route of PPI administration, Outcome 2: Rebleeding

Comparison 4: Subgroup analysis according to route of PPI administration, Outcome 3: Surgery

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Analysis 4.3

Comparison 4: Subgroup analysis according to route of PPI administration, Outcome 3: Surgery

Comparison 5: Subgroup analysis according to PPI dose (high dose versus non‐high dose), Outcome 1: Mortality

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Analysis 5.1

Comparison 5: Subgroup analysis according to PPI dose (high dose versus non‐high dose), Outcome 1: Mortality

Comparison 5: Subgroup analysis according to PPI dose (high dose versus non‐high dose), Outcome 2: Rebleeding

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Analysis 5.2

Comparison 5: Subgroup analysis according to PPI dose (high dose versus non‐high dose), Outcome 2: Rebleeding

Comparison 5: Subgroup analysis according to PPI dose (high dose versus non‐high dose), Outcome 3: Surgery

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Analysis 5.3

Comparison 5: Subgroup analysis according to PPI dose (high dose versus non‐high dose), Outcome 3: Surgery

Comparison 6: Subgroup analysis according to control treatment, Outcome 1: Mortality

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Analysis 6.1

Comparison 6: Subgroup analysis according to control treatment, Outcome 1: Mortality

Comparison 6: Subgroup analysis according to control treatment, Outcome 2: Rebleeding

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Analysis 6.2

Comparison 6: Subgroup analysis according to control treatment, Outcome 2: Rebleeding

Comparison 6: Subgroup analysis according to control treatment, Outcome 3: Surgery

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Analysis 6.3

Comparison 6: Subgroup analysis according to control treatment, Outcome 3: Surgery

Comparison 7: Subgroup analysis according to use of endoscopic haemostatic treatment at index endoscopy, Outcome 1: Mortality

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Analysis 7.1

Comparison 7: Subgroup analysis according to use of endoscopic haemostatic treatment at index endoscopy, Outcome 1: Mortality

Comparison 7: Subgroup analysis according to use of endoscopic haemostatic treatment at index endoscopy, Outcome 2: Rebleeding

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Analysis 7.2

Comparison 7: Subgroup analysis according to use of endoscopic haemostatic treatment at index endoscopy, Outcome 2: Rebleeding

Comparison 7: Subgroup analysis according to use of endoscopic haemostatic treatment at index endoscopy, Outcome 3: Surgery

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Analysis 7.3

Comparison 7: Subgroup analysis according to use of endoscopic haemostatic treatment at index endoscopy, Outcome 3: Surgery

Comparison 8: Sensitivity analysis restricted to peptic ulcer participants, Outcome 1: Mortality

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Analysis 8.1

Comparison 8: Sensitivity analysis restricted to peptic ulcer participants, Outcome 1: Mortality

Comparison 8: Sensitivity analysis restricted to peptic ulcer participants, Outcome 2: Rebleeding

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Analysis 8.2

Comparison 8: Sensitivity analysis restricted to peptic ulcer participants, Outcome 2: Rebleeding

Comparison 8: Sensitivity analysis restricted to peptic ulcer participants, Outcome 3: Surgery

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Analysis 8.3

Comparison 8: Sensitivity analysis restricted to peptic ulcer participants, Outcome 3: Surgery

Summary of findings 1. Proton pump inhibitor treatment compared to H2RA, placebo or no treatment in people with upper gastrointestinal bleeding prior to endoscopic diagnosis

Main analysis: proton pump inhibitor treatment compared to H2RA, placebo or no treatment in people with upper gastrointestinal bleeding prior to endoscopic diagnosis

Patient or population: people with upper gastrointestinal bleeding prior to endoscopic diagnosis
Setting: hospital setting (inpatients), any country (not limited to specific geographic locations or specific country income classifications) 
Intervention: proton pump inhibitor (PPI)
Comparison: histamine‐2 receptor antagonist (H2RA), placebo or no treatment

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

With control treatment

With PPI treatment
(95% CI)

Mortality ‐ within 30 days

Study population

OR 1.14
(0.76 to 1.70)

2143
(5 RCTs)

⊕⊕⊝⊝
Lowa,b

45 per 1000

6 more per 1000
(from 6 less to 30 more)

Rebleeding ‐ within 30 days

Study population

OR 0.81
(0.62 to 1.06)

2121
(5 RCTs)

⊕⊕⊝⊝
Lowc,d

131 per 1000

23 less per 1000
(from 45 less to 8 more)

Surgery ‐ within 30 days

Study population

OR 0.91
(0.65 to 1.26)

2223
(6 RCTs)

⊕⊕⊝⊝
Lowe,f

77 per 1000

6 less per 1000
(from 24 less to 18 more)

Proportion of participants with stigmata of recent haemorrhage at index endoscopy

Study population

OR 0.80
(0.52 to 1.21)

1332
(4 RCTs)

⊕⊕⊝⊝
Lowg,h

465 per 1000

42 less per 1000
(from 135 less to 74 more)

Endoscopic haemostatic treatment at index endoscopy

Study population

OR 0.68
(0.50 to 0.93)

1983
(3 RCTs)

⊕⊕⊕⊝
Moderatei

118 per 1000

33 less per 1000
(52 less to 8 less)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RR: risk ratio; OR: odds ratio

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

aThe certainty of evidence for mortality was rated down one level due to serious study limitations. Two of the five studies had high risk of bias (high risk of performance bias due to lack of blinding; unclear risk of selection bias due to unclear random sequence generation and unclear allocation concealment), and two other studies had unclear risk of bias (unclear risk of selection bias due to unclear allocation concealment). Of note, if by a 'sensitivity approach' the above‐mentioned four studies were excluded, then all the evidence would be derived from one RCT at low risk of bias (Lau 2007): the effect estimate would remain similar, and there would be no study limitations, but the imprecision would further worsen and would be considered very serious (due to very wide 95% CI and only 15 events in total) requiring rating down by two levels for imprecision; therefore, the certainty of evidence would be low with either approach.
bThe certainty of evidence for mortality was further downrated one level due to serious imprecision. The 95% CI of the pooled effect included no effect as well as clinically important benefit and clinically important harm. Small total number of events (102 in total).
cThe certainty of evidence for rebleeding was rated down one level due to serious study limitations. Two of the five studies had high risk of bias (high risk of performance bias and detection bias due to lack of blinding; unclear risk of selection bias due to unclear random sequence generation or unclear allocation concealment, or both), and the other two studies had unclear risk of bias (unclear risk of selection bias due to unclear allocation concealment). Of note, if by a 'sensitivity approach' the above‐mentioned four studies were excluded, then all the evidence would be derived from one RCT at low risk of bias (Lau 2007): the effect estimate would include both clinically important benefit and clinically important harm), and there would be no study limitations, but the imprecision would further worsen and would be considered very serious (due to very wide 95% CI and only 18 events in total) requiring rating down by two levels for imprecision; therefore, the certainty of evidence would be low with either approach.
dThe certainty of evidence for rebleeding was further downrated one level due to serious imprecision. The 95% CI of the pooled effect included no effect as well as clinically important benefit and small unimportant harm. Relatively small total number of events (255 in total).
eThe certainty of evidence for surgery was rated down one level due to serious study limitations. Three of the five studies had high risk of bias (high risk of performance bias and detection bias due to lack of blinding; unclear risk of selection bias due to unclear random sequence generation or unclear allocation concealment, or both), and two other studies had unclear risk of bias (unclear risk of selection bias due to unclear allocation concealment). Of note, if by a 'sensitivity approach' the above‐mentioned four studies were excluded, then all the evidence would be derived from one RCT at low risk of bias (Lau 2007): the effect estimate would remain similar, and there would be no study limitations, but the imprecision would further worsen and would be considered very serious (due to very wide 95% CI and only 10 events in total) requiring downrating by two levels for imprecision; therefore, the certainty of evidence would be low with either approach.
fThe certainty of evidence for surgery was further downrated one level due to serious imprecision. The 95% CI of the pooled effect included no effect as well as clinically important benefit and clinically important harm. Relatively small total number of events (163 in total).
gThe certainty of evidence for the proportion of participants with stigmata of recent haemorrhage at index endoscopy was downrated one level due to serious study limitations. Two of the four studies had high risk of bias (high risk of performance bias and detection bias due to lack of blinding; unclear risk of selection bias due to unclear random sequence generation or unclear allocation concealment, or both), and the other two studies had unclear risk of bias (unclear risk of selection bias due to unclear allocation concealment).
hThe certainty of evidence for the proportion of participants with stigmata of recent haemorrhage at index endoscopy was further downrated one level due to serious imprecision. The 95% CI of the pooled effect included no effect as well as clinically important benefit and clinically important harm.
iThe certainty of evidence for endoscopic haemostatic treatment at index endoscopy was downrated one level in total due to the combination of moderate study limitations, moderate indirectness and moderate imprecision. Two of the three studies had unclear risk of bias (unclear risk of selection bias due to unclear allocation concealment); the same two studies had indirectness because their criteria and technique for endoscopic haemostatic treatment were different from modern practice. However, these two studies contributed only a small proportion of the weight of the meta‐analysis (31% with random‐effects model, 26% with fixed‐effect model). If by a 'sensitivity approach' the above‐mentioned two studies were excluded, then all the evidence would be derived from one RCT at low risk of bias and without indirectness (Lau 2007): the effect estimate would remain identical, and there would be no study limitations, no indirectness but the imprecision would further worsen and would be considered serious (150 events in total) justifying downrating by one level for imprecision alone; therefore, the certainty of evidence would be moderate with either approach.

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Summary of findings 1. Proton pump inhibitor treatment compared to H2RA, placebo or no treatment in people with upper gastrointestinal bleeding prior to endoscopic diagnosis
Comparison 1. Main analysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Mortality Show forest plot

5

2143

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.77, 1.66]

1.2 Rebleeding Show forest plot

5

2121

Odds Ratio (M‐H, Random, 95% CI)

0.81 [0.62, 1.06]

1.3 Surgery Show forest plot

6

2223

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.65, 1.26]

1.4 Participants requiring blood transfusion Show forest plot

4

1512

Odds Ratio (M‐H, Random, 95% CI)

0.95 [0.75, 1.20]

1.5 Proportion of participants with stigmata of recent haemorrhage Show forest plot

4

1332

Odds Ratio (M‐H, Random, 95% CI)

0.80 [0.52, 1.21]

1.6 Proportion of participants with stigmata of recent haemorrhage plus Lau 2007 Show forest plot

5

1709

Odds Ratio (M‐H, Random, 95% CI)

0.68 [0.50, 0.93]

1.7 Proportion of participants with blood in stomach Show forest plot

3

1230

Odds Ratio (M‐H, Random, 95% CI)

0.64 [0.32, 1.30]

1.8 Proportion of participants with active bleeding Show forest plot

4

1332

Odds Ratio (M‐H, Random, 95% CI)

0.74 [0.53, 1.02]

1.9 Proportion of participants with active bleeding plus Lau 2007 Show forest plot

5

1709

Odds Ratio (M‐H, Random, 95% CI)

0.67 [0.47, 0.95]

1.10 Endoscopic haemostatic treatment at index endoscopy Show forest plot

3

1983

Odds Ratio (M‐H, Random, 95% CI)

0.68 [0.50, 0.93]

Figuras y tablas -
Comparison 1. Main analysis
Comparison 2. Subgroup analysis according to risk of bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Mortality Show forest plot

5

2143

Odds Ratio (M‐H, Random, 95% CI)

1.14 [0.76, 1.70]

2.1.1 low or unclear risk of bias

3

1983

Odds Ratio (M‐H, Random, 95% CI)

1.20 [0.79, 1.84]

2.1.2 high risk of bias

2

160

Odds Ratio (M‐H, Random, 95% CI)

0.66 [0.18, 2.46]

2.2 Rebleeding Show forest plot

5

2121

Odds Ratio (M‐H, Random, 95% CI)

0.81 [0.62, 1.06]

2.2.1 low or unclear risk of bias

3

1983

Odds Ratio (M‐H, Random, 95% CI)

0.87 [0.65, 1.16]

2.2.2 high risk of bias

2

138

Odds Ratio (M‐H, Random, 95% CI)

0.45 [0.19, 1.03]

2.3 Surgery Show forest plot

6

2223

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.65, 1.26]

2.3.1 low or unclear risk of bias

3

1983

Odds Ratio (M‐H, Random, 95% CI)

0.90 [0.64, 1.27]

2.3.2 high risk of bias

3

240

Odds Ratio (M‐H, Random, 95% CI)

0.85 [0.22, 3.37]

2.4 Proportion of participants with stigmata of recent haemorrhage Show forest plot

4

1332

Odds Ratio (M‐H, Random, 95% CI)

0.80 [0.52, 1.21]

2.4.1 low or unclear risk of bias

2

1172

Odds Ratio (M‐H, Random, 95% CI)

0.79 [0.40, 1.55]

2.4.2 high risk of bias

2

160

Odds Ratio (M‐H, Random, 95% CI)

1.01 [0.46, 2.19]

2.5 Endoscopic haemostatic treatment at index endoscopy Show forest plot

3

1983

Odds Ratio (M‐H, Random, 95% CI)

0.68 [0.50, 0.93]

2.5.1 low or unclear risk of bias

3

1983

Odds Ratio (M‐H, Random, 95% CI)

0.68 [0.50, 0.93]

Figuras y tablas -
Comparison 2. Subgroup analysis according to risk of bias
Comparison 3. Subgroup analysis according to geographic location

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Mortality Show forest plot

5

2143

Odds Ratio (M‐H, Random, 95% CI)

1.14 [0.76, 1.70]

3.1.1 Asian

2

689

Odds Ratio (M‐H, Random, 95% CI)

1.13 [0.43, 2.96]

3.1.2 Non‐Asian

3

1454

Odds Ratio (M‐H, Random, 95% CI)

0.96 [0.48, 1.94]

3.2 Rebleeding Show forest plot

5

2121

Odds Ratio (M‐H, Random, 95% CI)

0.81 [0.62, 1.06]

3.2.1 Asian

2

689

Odds Ratio (M‐H, Random, 95% CI)

1.04 [0.45, 2.40]

3.2.2 Non‐Asian

3

1432

Odds Ratio (M‐H, Random, 95% CI)

0.78 [0.59, 1.04]

3.3 Surgery Show forest plot

6

2223

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.65, 1.26]

3.3.1 Asian

2

689

Odds Ratio (M‐H, Random, 95% CI)

0.67 [0.19, 2.39]

3.3.2 Non‐Asian

4

1534

Odds Ratio (M‐H, Random, 95% CI)

0.93 [0.66, 1.30]

Figuras y tablas -
Comparison 3. Subgroup analysis according to geographic location
Comparison 4. Subgroup analysis according to route of PPI administration

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Mortality Show forest plot

5

2143

Odds Ratio (M‐H, Random, 95% CI)

1.14 [0.76, 1.70]

4.1.1 Oral PPI

1

205

Odds Ratio (M‐H, Random, 95% CI)

0.39 [0.07, 2.07]

4.1.2 Intravenous PPI

4

1938

Odds Ratio (M‐H, Random, 95% CI)

1.21 [0.80, 1.85]

4.2 Rebleeding Show forest plot

5

2121

Odds Ratio (M‐H, Random, 95% CI)

0.81 [0.62, 1.06]

4.2.1 Oral PPI

1

205

Odds Ratio (M‐H, Random, 95% CI)

1.01 [0.40, 2.54]

4.2.2 Intravenous PPI

4

1916

Odds Ratio (M‐H, Random, 95% CI)

0.79 [0.55, 1.13]

4.3 Surgery Show forest plot

6

2223

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.65, 1.26]

4.3.1 Oral PPI

1

205

Odds Ratio (M‐H, Random, 95% CI)

0.49 [0.12, 2.01]

4.3.2 Intravenous PPI

5

2018

Odds Ratio (M‐H, Random, 95% CI)

0.94 [0.67, 1.31]

Figuras y tablas -
Comparison 4. Subgroup analysis according to route of PPI administration
Comparison 5. Subgroup analysis according to PPI dose (high dose versus non‐high dose)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 Mortality Show forest plot

5

2143

Odds Ratio (M‐H, Random, 95% CI)

1.14 [0.76, 1.70]

5.1.1 High dose PPI

1

631

Odds Ratio (M‐H, Random, 95% CI)

1.16 [0.41, 3.23]

5.1.2 Non‐high dose PPI

4

1512

Odds Ratio (M‐H, Random, 95% CI)

1.13 [0.73, 1.76]

5.2 Rebleeding Show forest plot

5

2121

Odds Ratio (M‐H, Random, 95% CI)

0.81 [0.62, 1.06]

5.2.1 High dose PPI

1

631

Odds Ratio (M‐H, Random, 95% CI)

1.40 [0.56, 3.53]

5.2.2 Non‐high dose PPI

4

1490

Odds Ratio (M‐H, Random, 95% CI)

0.77 [0.58, 1.02]

5.3 Surgery Show forest plot

6

2223

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.65, 1.26]

5.3.1 High dose PPI

1

631

Odds Ratio (M‐H, Random, 95% CI)

0.67 [0.19, 2.39]

5.3.2 Non‐high dose PPI

5

1592

Odds Ratio (M‐H, Random, 95% CI)

0.93 [0.66, 1.30]

Figuras y tablas -
Comparison 5. Subgroup analysis according to PPI dose (high dose versus non‐high dose)
Comparison 6. Subgroup analysis according to control treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 Mortality Show forest plot

5

2143

Odds Ratio (M‐H, Random, 95% CI)

1.14 [0.76, 1.70]

6.1.1 PPI versus placebo

3

1983

Odds Ratio (M‐H, Random, 95% CI)

1.20 [0.79, 1.84]

6.1.2 PPI versus H2RA

2

160

Odds Ratio (M‐H, Random, 95% CI)

0.66 [0.18, 2.46]

6.2 Rebleeding Show forest plot

5

2121

Odds Ratio (M‐H, Random, 95% CI)

0.81 [0.62, 1.06]

6.2.1 PPI versus placebo

3

1983

Odds Ratio (M‐H, Random, 95% CI)

0.87 [0.65, 1.16]

6.2.2 PPI versus H2RA

1

58

Odds Ratio (M‐H, Random, 95% CI)

0.56 [0.14, 2.26]

6.2.3 PPI versus no treatment

1

80

Odds Ratio (M‐H, Random, 95% CI)

0.39 [0.14, 1.12]

6.3 Surgery Show forest plot

6

2223

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.65, 1.26]

6.3.1 PPI versus placebo

3

1983

Odds Ratio (M‐H, Random, 95% CI)

0.90 [0.64, 1.27]

6.3.2 PPI versus H2RA

2

160

Odds Ratio (M‐H, Random, 95% CI)

1.53 [0.45, 5.18]

6.3.3 PPI versus no treatment

1

80

Odds Ratio (M‐H, Random, 95% CI)

0.37 [0.07, 2.02]

Figuras y tablas -
Comparison 6. Subgroup analysis according to control treatment
Comparison 7. Subgroup analysis according to use of endoscopic haemostatic treatment at index endoscopy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

7.1 Mortality Show forest plot

5

2143

Odds Ratio (M‐H, Random, 95% CI)

1.14 [0.76, 1.70]

7.1.1 Reported use of endoscopic haemostatic treatment at index endoscopy

4

2041

Odds Ratio (M‐H, Random, 95% CI)

1.20 [0.78, 1.82]

7.1.2 No mention of endoscopic haemostatic treatment at index endoscopy

1

102

Odds Ratio (M‐H, Random, 95% CI)

0.60 [0.14, 2.66]

7.2 Rebleeding Show forest plot

5

2121

Odds Ratio (M‐H, Random, 95% CI)

0.81 [0.62, 1.06]

7.2.1 Reported use of endoscopic haemostatic treatment at index endoscopy

4

2041

Odds Ratio (M‐H, Random, 95% CI)

0.85 [0.65, 1.13]

7.2.2 No mention of endoscopic haemostatic treatment at index endoscopy

1

80

Odds Ratio (M‐H, Random, 95% CI)

0.39 [0.14, 1.12]

7.3 Surgery Show forest plot

6

2223

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.65, 1.26]

7.3.1 Reported use of endoscopic haemostatic treatment at index endoscopy

4

2041

Odds Ratio (M‐H, Random, 95% CI)

0.90 [0.64, 1.27]

7.3.2 No mention of endoscopic haemostatic treatment at index endoscopy

2

182

Odds Ratio (M‐H, Random, 95% CI)

0.85 [0.22, 3.37]

Figuras y tablas -
Comparison 7. Subgroup analysis according to use of endoscopic haemostatic treatment at index endoscopy
Comparison 8. Sensitivity analysis restricted to peptic ulcer participants

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

8.1 Mortality Show forest plot

2

580

Odds Ratio (M‐H, Random, 95% CI)

1.39 [0.52, 3.70]

8.2 Rebleeding Show forest plot

2

880

Odds Ratio (M‐H, Fixed, 95% CI)

0.86 [0.59, 1.26]

8.3 Surgery Show forest plot

2

880

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.59, 1.40]

Figuras y tablas -
Comparison 8. Sensitivity analysis restricted to peptic ulcer participants