Intravenous Non-high-dose Pantoprazole is equally effective as High-dose Pantoprazole in Preventing Rebleeding among Low Risk Patients with a Bleeding Peptic Ulcer after Initial Endoscopic Hemostasis.
BMC Gastroenterol. 2012 Mar 28;12(1):28
Authors: Liang CM, Lee JH, Kuo YH, Wu KL, Chiu YC, Chou YP, Hu ML, Tai WC, Chiu KW, Hu TH, Chuah SK
Abstract
ABSTRACT: BACKGROUND: Many studies have shown that high-dose proton-pumps inhibitors (PPI) do not further reduce the rate of rebleeding compared to non-high-dose PPIs but we do not know whether intravenous non-high-dose PPIs reduce rebleeding rates among patients at low risk (Rockall score <6) or among those at high risk, both compared to high-dose PPIs. This retrospective case-controlled study aimed to identify the subgroups of these patients that might benefit from treatment with non-high-dose PPIs. METHODS: Subjects who received high dose and non-high-dose pantoprazole for confirmed acute PU bleeding at a tertiary referral hospital were enrolled (n=413). They were divided into sustained hemostasis (n=324) and rebleeding groups (n=89). The greedy method was applied to allow treatment-control random matching (1:1). Patients were randomly selected from the non-high-dose and high-dose PPI groups who had a high risk peptic ulcer bleeding (n=104 in each group), and these were then subdivided to two subgroups (Rockall score >6 vs.<6, n=77 vs. 27). RESULTS: An initial low hemoglobin level, serum creatinine level, and Rockall score were independent factors associated with rebleeding. After case-control matching, the significant variables between the non-high-dose and high-dose PPI groups for a Rockall score >6 were the rebleeding rate, and the amount of blood transfused. Case-controlled matching for the subgroup with a Rockall score <6 showed that the rebleeding rate was similar for both groups (11.1% in each group). CONCLUSIONS: : Intravenous non-high-dose pantoprazole is equally effective as high-dose pantoprazole when treating low risk patients with a Rockall sore were <6 who have bleeding ulcers and high-risk stigmata after endoscopic hemostasis.
PMID: 22455511 [PubMed - as supplied by publisher]