Intragastric pH with oral vs intravenous bolus plus infusion proton-pump inhibitor therapy in patients with bleeding ulcers.
OBJECTIVE
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 randomly 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 cannot 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.
Laine
Loren
L
Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. llaine@usc.edu
Shah
Abbid
A
Bemanian
Shahrooz
S
D000284:Administration, Oral; D004334:Drug Administration Schedule; D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000378:metabolism; D004384:Duodenoscopy; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005745:Gastric Acidity Determination; D005773:Gastroscopy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000378:metabolism; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D013276:Stomach Ulcer / Q000188:drug therapy* / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors