Effect of intravenous proton pump inhibitor regimens and timing of endoscopy on clinical outcomes of peptic ulcer bleeding.
J Gastroenterol Hepatol. 2012 May 31;
Authors: Liu N, Liu L, Zhang H, Cp G, Zhang D, Yao L, Yang Y, Wu K, Ding J, Fan D
Background and Aim:? The most effective schedule of PPI administration and the optimal timing of endoscopy in acute peptic ulcer bleeding remain uncertain. The aim of this study is to determine the most efficient PPI regimen and optimal timing of endoscopy. Methods:? Consecutive patients with suspected bleeding peptic ulcers were enrolled and randomized to receive either a standard regimen or a high-dose intensive IV regimen. Only patients with bleeding peptic ulcers diagnosed at initial endoscopy continued the study. High-risk patients received endoscopic hemostasis. The primary outcome measure of recurrent bleeding was compared between the two dosage regimens and between early and late endoscopy. Secondary outcome measures compared included need for endoscopic treatment, blood transfusion, hospital stay, surgery and mortality. Results:? A total of 875 patients completed the study. Recurrent bleeding occurred in 11.0% in the standard regimen group, statistically higher than that in the intensive regimen group (6.4%, P=0.02). Mean units of blood transfused and duration of hospital stay were also higher in the standard regimen group (P<0.001 for each compared to intensive regimen group). However, no significant differences were noted between the two groups in the need for endoscopic hemostasis, need for surgery, and mortality. Recurrence of bleeding was similar between the early and late endoscopy. Units of blood transfused and length of hospital stay were both significantly reduced with early endoscopy. Discussion:? High-dose PPI infusion is more efficacious in reducing rebleeding rate, blood transfusion requirements and hospital stay. Early endoscopy is safe and more effective than late endoscopy. © 2012 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
PMID: 22646140 [PubMed - as supplied by publisher]