***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS We aim ed to assess the clinical effectiveness of oral vs. intravenous ( i.v . ) regular-dose proton pump inhibitor ( PPI ) after endoscopic injection of epinephrine in patients with peptic ulcer bleeding . METHODS Peptic ulcer patients with active bleeding , nonbleeding visible vessels , or adherent clots were enrolled after successful endoscopic haemostasis achieved by epinephrine injection . They were r and omized to receive either oral rabeprazole ( RAB group , 20 mg twice daily for 3 days ) or i.v . omeprazole ( OME group , 40 mg i.v . infusion every 12 h for 3 days ) . Subsequently , the enrolled patients receive oral PPI for 2 months ( rabeprazole 20 mg or esomeprazole 40 mg once daily ) . The primary end-point was recurrent bleeding up to 14 days . The hospital stay , blood transfusion , surgery and mortality within 14 days were compared as well . RESULTS A total of 156 patients were enrolled , with 78 patients r and omly allocated in each group . The two groups were well matched for factors affecting the clinical outcomes . Primary end-points ( recurrent bleeding up to 14 days ) were reached in 12 patients ( 15.4 % ) in the OME group and 13 patients ( 16.7 % ) in the RAB group [ 95 % confidence interval ( CI ) of difference -12.82 , 10.22 ] . All the rebleeding events occurred within 3 days of enrolment . The two groups were not different in hospital stay , volume of blood transfusion , surgery or mortality rate ( 1.3 % of the OME group and 2.6 % of the RAB group died , 95 % CI of difference -5.6 , 3.0 ) . CONCLUSIONS Oral rabeprazole and i.v . regular-dose omeprazole are equally effective in preventing rebleeding in patients with high-risk bleeding peptic ulcers after successful endoscopic injection with epinephrine BACKGROUND & AIMS Intravenous bolus plus infusion proton pump inhibitor ( PPI ) therapy is recommended for patients with bleeding ulcers and higher risk stigmata . If frequent oral dosing of PPIs provided similar antisecretory effect , this might be preferred based on ease and cost . METHODS Patients presenting with overt bleeding due to ulcers had intragastric pH probes placed after endoscopy and baseline pH recorded . They were r and omly assigned to intravenous lansoprazole ( 90-mg bolus followed by 9-mg/h infusion ) or oral lansoprazole ( 120-mg bolus followed by 30 mg every 3 hours ) . pH was recorded for 24 hours . RESULTS Intragastric pH was > 6 for 67.8 % of the study period with intravenous PPI ( n = 32 ) and 64.8 % with oral PPI ( n = 34 ) : difference , 3.0 % ; 95 % confidence interval ( CI ) : -9.2 % to 15.2 % . Intragastric pH was > 6 for > 60 % of the study period in 22 ( 68.8 % ) patients receiving intravenous and 22 ( 64.7 % ) patients receiving oral PPI : difference , 4.0 % ; 95 % CI : -18.7 % to 26.8 % . At 1 hour , mean pHs for intravenous vs oral were 5.3 + /- 0.4 vs 3.3 + /- 0.4 , respectively ( difference , 2.0 ; 95 % CI : 0.8 - 3.1 ; P = .001 ) . At > or = 1.5 hours , 95 % CIs of the differences for all hourly mean pHs included zero . Mean pH rose above 6 after 2 - 3 hours of intravenous PPI and 3 - 4 hours of oral PPI . CONCLUSIONS Frequent oral PPI may be able to replace the currently recommended intravenous bolus plus infusion PPI therapy in patients with bleeding ulcers , although the possibility that intravenous PPIs are superior can not be definitively excluded given our relatively wide confidence intervals . Intravenous PPI provides more rapid increase in pH , reaching mean pH of 6 approximately 1 hour sooner than oral PPI DESCRIPTION A multidisciplinary group of 34 experts from 15 countries developed this up date and expansion of the recommendations on the management of acute nonvariceal upper gastrointestinal bleeding ( UGIB ) from 2003 . METHODS The Appraisal of Guidelines for Research and Evaluation ( AGREE ) process and independent ethics protocol s were used . Sources of data included original and published systematic review s ; r and omized , controlled trials ; and abstract s up to October 2008 . Quality of evidence and strength of recommendations have been rated by using the Grading of Recommendations Assessment , Development , and Evaluation ( GRADE ) criteria . RECOMMENDATIONS Recommendations emphasize early risk stratification , by using vali date d prognostic scales , and early endoscopy ( within 24 hours ) . Endoscopic hemostasis remains indicated for high-risk lesions , whereas data support attempts to dislodge clots with hemostatic , pharmacologic , or combination treatment of the underlying stigmata . Clips or thermocoagulation , alone or with epinephrine injection , are effective methods ; epinephrine injection alone is not recommended . Second-look endoscopy may be useful in selected high-risk patients but is not routinely recommended . Preendoscopy proton-pump inhibitor ( PPI ) therapy may downstage the lesion ; intravenous high-dose PPI therapy after successful endoscopic hemostasis decreases both rebleeding and mortality in patients with high-risk stigmata . Although selected patients can be discharged promptly after endoscopy , high-risk patients should be hospitalized for at least 72 hours after endoscopic hemostasis . For patients with UGIB who require a nonsteroidal anti-inflammatory drug , a PPI with a cyclooxygenase-2 inhibitor is preferred to reduce rebleeding .  Patients with UGIB who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid ( ASA ) again as soon as cardiovascular risks outweigh gastrointestinal risks ( usually within 7 days ) ; ASA plus PPI therapy is preferred over clopidogrel alone to reduce rebleeding BACKGROUND In patients with peptic ulcer bleeding , acid can enhance platelet disaggregation and cause lysis of the clot . Omeprazole , a potent acid suppressor , may be helpful in reducing their rebleeding rate . METHODS Between March and October 1994 , 40 patients with a non-bleeding , visible vessel ( NBVV ) at ulcer bases were enrolled for study . They were r and omized into four groups . Group 1 ( n = 10 ) patients received cimetidine 300 mg intravenously ( i.v . ) q6h ; Group II ( n = 10 ) patients received heater probe thermocoagulation therapy and cimetidine 300 mg i.v . q6h ; Group III ( n = 10 ) patients received omeprazole 40 mg intravenous bolus initially followed by 40 mg i.v . qd and Group IV ( n = 10 ) patients received omeprazole 40 mg intravenous bolus initially followed by 40 mg i.v . q12h . Endoscopic examination was done for follow-up , daily , for 1 - 3 days . RESULTS Preliminary results showed that the age , initial hemoglobin , ulcer size as well as NBVV size in Groups I-IV were not significantly different ( p < 0.05 ) . The rebleeding rates were 40 % in Group I , 20 % in Group II , 20 % in Group III and 0 % in Group IV , ( p < 0.05 when Group IV is compared with Group I ) . CONCLUSIONS Intravenous omeprazole 40 mg given q12h can reduce the rebleeding rate of patients with a NBVV Objective : We sought to compare a 2-day quadruple therapy with a 14-day triple therapy in the treatment of Helicobacter pylori infection . Methods : Eighty-one consecutive patients with an endoscopically diagnosed peptic ulcer and demonstrated infection by H. pylori were included in the study . Patients were r and omized to receive omeprazole 40 mg b.i.d . , amoxicillin 2.5 g once daily , metronidazole 500 mg t.i.d . , and bismuth subcitrate 360 mg t.i.d . for 2 days , followed by omeprazole 20 mg once daily for 6 additional days ( Group 1 ) or a 14-day course of omeprazole 20 mg b.i.d . , amoxicillin 1 g t.i.d . , and metronidazole 500 mg t.i.d . ( Group 2 ) . Eradication was evaluated by antral biopsy and rapid urease test at 2 months after therapy and by C13-urea breath test after a year . Results : Two patients were lost to follow-up at 2 months . Intention-to-treat analysis showed that H. pylori infection was cured in 29 of 42 patients ( 69 % ; 95 % CI : 53–82 % ) in Group 1 versus 36 of 39 ( 92 % ; 95 % CI : 78–98 % ) of patients in Group 2 ( p= 0.009 ) . Per- protocol analysis showed a cure rate of 71 % ( 95 % CI : 55–84 % ) ( 29/41 patients ) and 95 % ( 95 % CI : 81–99 % ) ( 36/38 patients ) , respectively ( p= 0.007 ) . Fifty-five of 65 cured patients returned 1 year after treatment ( 26 in Group 1 , 29 in Group 2 ) . All but one in Group 2 remained cured . There were no significant differences in compliance ( 88 % in Group 1 versus 92 % in Group 2 ) or in the presence of side effects ( 27 % ; 95 % CI : 15–43%versus 41 % ; 95 % CI : 26–58 % ; ns ) . Conclusion : Two-day quadruple therapy is significantly less effective than 2-wk triple treatment Proton pump inhibitors ( PPIs ) reduce the rate of rebleeding in patients with nonvariceal upper GI bleed ( NVGIB ) . Oral ( PO ) and intravenous ( IV ) pantoprazole are equipotent in raising gastric pH. We conducted a pilot study comparing the efficacy of PO vs. IV pantoprazole for reducing rebleeding after NVGIB . Patients with NVGIB were r and omized to receive PO ( 80 mg BID for 3 days ) or IV  ( 80-mg IV bolus and 8 mg/hr infusion for 3 days ) pantoprazole followed by pantoprazole , 40 mg PO BID , for 30 days . All patients underwent endoscopy within 24 hr and endotherapy was applied where necessary . Twelve patients r and omized to the PO and 13 to the IV pantoprazole group were comparable in age , hematocrit , Rockall scores , ulcer characteristics , and endoscopic interventions . Two patients in the IV arm rebled and another in the IV arm developed reversible renal failure . No patient in the PO arm rebled , had organ failure , or had to be changed to IV pantoprazole . We conclude that in this pilot study , the effect of PO pantoprazole on 30-day rebleeding rate in patients with NVGIB was similar to that of IV pantoprazole Background and Aim : Rebleeding has remained the most important determinant of poor prognosis in peptic ulcer bleeding . Gastric acid plays an important role in the pathogenesis of rebleeding . We aim ed to compare the efficiency of intermittent and continuous pantoprazole infusion treatment on peptic ulcer rebleeding after endoscopic therapy . Material s and Method : In this prospect i ve study , patients with active peptic ulcer bleeding or non-bleeding visible vessel were treated initially with endoscopic therapy . They were r and omized to receive intermittent or continuous intravenous pantoprazole treatment .  Rebleeding rate , duration of hospital stay , need for total blood transfusion and need for urgent surgery were compared among both groups . Results : Rebleeding rate ( 6.1 vs. 8.3 % ) , duration of hospital stay ( 4.17 vs. 4.41 ) , need for total blood transfusion ( 2.18 vs. 2.59 ) and need for urgent surgery ( 4.1 vs. 4.2 % ) were similar in intermittent and continuous pantoprazole infusion therapy groups , respectively . There was no bleeding-related death in either group . Conclusion : In patients with peptic ulcer bleeding , intermittent and continuous pantoprazole infusion after successful endoscopic therapy have comparable outcomes in reducing rebleeding . Both have similar effects on hospital stay , need for blood transfusion and urgent surgery . Intermittent administration has application and cost advantages over continuous infusion BACKGROUND Patients with comorbidities have an increased risk of ulcer rebleeding , especially within the 28 days after endoscopic ther 
    Output:
    
We found low quality evidence that did not exclude a potential reduction or increase in mortality , rebleeding , surgical interventions or endoscopic haemostatic treatment ( EHT ) with " high " dose regimens .
There was visual and statistical evidence of " inverse " publication bias for mortality ( missing small studies with favourable outcomes for " high " dose ) , but not for any other outcome .
There is insufficient evidence for concluding superiority , inferiority or equivalence of high dose PPI treatment over lower doses in peptic ulcer bleeding