{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:48:51Z","timestamp":1791600531478,"version":"4.3.4"},"reference-count":31,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Continuous high-dose intravenous proton pump inhibitor (PPI) infusion is commonly used following endoscopic hemostasis for bleeding peptic ulcers, despite uncertainty regarding its clinical advantage over intermittent administration. This systematic review and meta-analysis evaluated whether continuous infusion improves clinically relevant outcomes compared with intermittent intravenous bolus therapy. Methods: A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, and Embase was conducted from inception through to 29 June 2026 to identify randomized controlled trials. Effect estimates were pooled using random-effects models with restricted maximum-likelihood estimation and Hartung\u2013Knapp adjustment. Risk of bias was assessed using RoB 2 and certainty of evidence using GRADE. The protocol was retrospectively registered on OSF. Results: Twelve randomized controlled trials involving 1726 participants were included. Across 11 trials (1621 participants), the pooled estimate did not demonstrate a statistically significant reduction in overall rebleeding with continuous infusion compared with intermittent bolus therapy (RR 0.93, 95% CI 0.65\u20131.35; I2 = 1.4%). Likewise, the pooled estimates did not demonstrate superiority of continuous infusion for rebleeding within 24 h (RR 0.70, 95% CI 0.09\u20135.64), rebleeding within 7 days (RR 1.07, 95% CI 0.66\u20131.72), surgery (RR 1.42, 95% CI 0.80\u20132.53), or mortality (RR 1.76, 95% CI 0.90\u20133.44). Moderate-certainty evidence indicated little or no clinically important difference in blood units transfused or hospital stay. Certainty was very low for rebleeding outcomes and low for surgery and mortality. Conclusions: Continuous intravenous PPI infusion was not shown to be superior to intermittent intravenous bolus therapy following successful endoscopic hemostasis. However, the very low- to low-certainty evidence for rebleeding, surgery, and mortality establishes neither equivalence nor noninferiority and does not exclude clinically important benefit or harm. The available trials do not identify the optimal intermittent dose or dosing frequency.<\/jats:p>","DOI":"10.3390\/jcm15197743","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:40:17Z","timestamp":1791596417000},"page":"7743","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Continuous Infusion Versus Intermittent Bolus Proton Pump Inhibitor Therapy Following Endoscopic Hemostasis for Bleeding Peptic Ulcers: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9403-1566","authenticated-orcid":false,"given":"Jos\u00e9 Luis","family":"Mu\u00f1oz-Carrillo","sequence":"first","affiliation":[{"name":"Laboratorio de Inmunolog\u00eda, Centro Universitario de los Lagos, Universidad de Guadalajara, Enrique D\u00edaz de Le\u00f3n 1144, Paseos de La Monta\u00f1a, Lagos de Moreno 47463, Jalisco, Mexico"},{"name":"Centro de Investigaci\u00f3n e Innovaci\u00f3n Global University (CIIGU), Av Independencia 2134, Trojes de Alonso, Aguascalientes 20116, Aguascalientes, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Basti\u00e9n-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Especialidad en Medicina Interna, Universidad Aut\u00f3noma de Aguascalientes, Av Universidad 940, Ciudad Universitaria, Aguascalientes 20100, Aguascalientes, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0163-1473","authenticated-orcid":false,"given":"Edrei","family":"Lopez-Hernandez","sequence":"additional","affiliation":[{"name":"Facultad de Medicina Campus Xalapa, Unidad de Ciencias de la Salud, Universidad Veracruzana, M\u00e9dicos y Odont\u00f3logos S\/N, Unidad del Bosque, Xalapa de Enriquez 91010, Veracruz, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"Guerrero-Toralva","sequence":"additional","affiliation":[{"name":"Facultad de Medicina Campus Xalapa, Unidad de Ciencias de la Salud, Universidad Veracruzana, M\u00e9dicos y Odont\u00f3logos S\/N, Unidad del Bosque, Xalapa de Enriquez 91010, Veracruz, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frida Sofia","family":"Ontiveros-Ramos","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Instituto de Ciencias Biom\u00e9dicas, Universidad Aut\u00f3noma de Ciudad Juarez, Plutarco El\u00edas Calles 1210, Fraccionamiento Fovissste Chamizal, Ciudad Ju\u00e1rez 32310, Chihuahua, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"Vargas-Flores","sequence":"additional","affiliation":[{"name":"Escuela Nacional de Medicina y Homeopat\u00eda, Instituto Polit\u00e9cnico Nacional, Av Guillermo Massieu Helguera 239, La Pur\u00edsima Ticoman, Gustavo A. Madero, Ciudad de M\u00e9xico 0732, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adair Zabdiel","family":"Cort\u00e9s-Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Facultad de Medicina Campus Xalapa, Unidad de Ciencias de la Salud, Universidad Veracruzana, M\u00e9dicos y Odont\u00f3logos S\/N, Unidad del Bosque, Xalapa de Enriquez 91010, Veracruz, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8018-4094","authenticated-orcid":false,"given":"Francisca","family":"Ch\u00e1vez-Ruvalcaba","sequence":"additional","affiliation":[{"name":"Licenciatura en Nutrici\u00f3n, Unidad Acad\u00e9mica de Enfermer\u00eda, Universidad Aut\u00f3noma de Zacatecas, Carretera Zacatecas-Guadalajara Km. 6, Ejido La Escondida, Zacatecas 98160, Zacatecas, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Rodr\u00edguez-Cort\u00e9s","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad El Bosque, Bogot\u00e1 110121, PC, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1819-1143","authenticated-orcid":false,"given":"Oscar","family":"Guti\u00e9rrez-Coronado","sequence":"additional","affiliation":[{"name":"Laboratorio de Inmunolog\u00eda, Centro Universitario de los Lagos, Universidad de Guadalajara, Enrique D\u00edaz de Le\u00f3n 1144, Paseos de La Monta\u00f1a, Lagos de Moreno 47463, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"18020","DOI":"10.1038\/nrdp.2018.20","article-title":"Non-Variceal Upper Gastrointestinal Bleeding","volume":"4","author":"Lanas","year":"2018","journal-title":"Nat. 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