Randomized trial comparing pantoprazole infusion, bolus and no treatment on gastric pH and recurrent bleeding in peptic ulcers.
BACKGROUND
To study the effects of pantoprazole on gastric pH and recurrent bleeding after endoscopic treatment for bleeding peptic ulcers.


METHODS
After endoscopic haemostasis, patients were randomly assigned to infusion group (pantoprazole 80 mg i.v. bolus followed by continuous infusion of 8 mg/h for 3 days), bolus group (pantoprazole 80 mg i.v. bolus followed by 40 mg i.v. bolus every 12 h for 3 days) and no-treatment group (no acid suppression in the first 3 days). Gastric pH was monitored. Rebleeding rate within 30 days, the need for surgery, transfusion requirement, total hospital stay, mortality rate and gastric pH were compared.


RESULTS
One hundred and sixty-eight patients were included, with 15 patients excluded from the analysis. There were 54 patients in the infusion group, 49 in the bolus group and 50 in the no-treatment group. There was fewer rebleeding (3.7 vs 16.0%, P = 0.034), less operative intervention (0 vs 8.0%, P = 0.034) and shorter hospital stay (6.4 vs 8.2 days, P = 0.040) in the infusion group compared with that in no-treatment group. When the bolus group was compared with no-treatment group, there were fewer rebleed (4.1 vs 16.0%, P = 0.049) and less blood transfusion (1.5 vs 2.9 units, P = 0.007). There was no difference in mortality among the three groups. Patients who received either pantoprazole infusion or bolus had significantly higher mean pH and longer duration of pH above 6 compared with the no-treatment group. There was no difference in the rebleeding rate, transfusion requirement, need for operation and hospital stay between the infusion and bolus groups. The mean pH and the duration of pH above 6 were also similar.


CONCLUSIONS
Pantoprazole either as infusion or bolus decreased rebleeding after endoscopic treatment for bleeding peptic ulcer.
Hung
Wai-Ka
WK
Department of Surgery, Kwong Wah Hospital, Hong Kong, China. hwkhwk@netvigator.com
Li
Vicky K M
VK
Chung
Chi-Kin
CK
Ying
Marcus W L
MW
Loo
Ching-Kong
CK
Liu
Cecilia K T
CK
Lam
Billy Y K
BY
Chan
Miranda C M
MC
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001803:Blood Transfusion; D005260:Female; D005745:Gastric Acidity Determination; D005750:Gastric Juice / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000601:surgery; D012008:Recurrence
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D000077402:Pantoprazole