title: High- versus low-dose proton pump inhibitors after endoscopic hemostasis in patients with peptic ulcer bleeding: a multicentre, randomized study.
abstract: BACKGROUND
  The most effective schedule of proton pump inhibitor (PPI) administration following endoscopic hemostasis of bleeding ulcers remains uncertain.
  
  
  METHODS
  Patients with actively bleeding ulcers and those with nonbleeding visible vessel or adherent clot were treated with epinephrine injection and/or thermal coagulation, and randomized to receive intravenous PPIs according to an intensive regimen (80 mg bolus followed by 8 mg/h as continuous infusion for 72 h) or a standard regimen (40 mg bolus daily followed by saline infusion for 72 h). After the infusion, all patients were given 20 mg PPI twice daily orally. The primary end point was the in-hospital rebleeding rate, as ascertained at the repeat endoscopy.
  
  
  RESULTS
  Bleeding recurred in 28 of 238 patients (11.8%) receiving the intensive regimen, and in 19 of 236 (8.1%) patients receiving the standard regimen (P= 0.18). Most rebleeding episodes occurred during the initial 72-h infusion: 18 (7.6%) and 19 events (8.1%) in the intensive and standard groups, respectively (P= 0.32). Mean units of blood transfused were 1.7 +/- 2.1 in the intensive and 1.5 +/- 2.1 in the standard regimen group (P= 0.34). The duration of hospital stay was <5 days for 88 (37.0%) and 111 patients (47.0%) in the intensive and standard groups (P= 0.03). There were fewer surgical interventions in the standard versus intensive regimen (1 vs 3). Five patients in each treatment group died.
  
  
  CONCLUSIONS
  Following endoscopic hemostasis of bleeding ulcers, standard-dose PPIs infusion was as effective as a high-dose regimen in reducing the risk of recurrent bleeding. (ClinicalTrials.gov number, NCT00374101).
authors.affiliation: Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni, Rotondo, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Andriulli
authors.forename: Silvano
authors.initials: S
authors.lastname: Loperfido
authors.forename: Rosaria
authors.initials: R
authors.lastname: Focareta
authors.forename: Pietro
authors.initials: P
authors.lastname: Leo
authors.forename: Fabio
authors.initials: F
authors.lastname: Fornari
authors.forename: Antonietta
authors.initials: A
authors.lastname: Garripoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Tonti
authors.forename: Sergio
authors.initials: S
authors.lastname: Peyre
authors.forename: Antonio
authors.initials: A
authors.lastname: Spadaccini
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marmo
authors.forename: Antonio
authors.initials: A
authors.lastname: Merla
authors.forename: Alessandro
authors.initials: A
authors.lastname: Caroli
authors.forename: Gian Battista
authors.initials: GB
authors.lastname: Forte
authors.forename: Angelo
authors.initials: A
authors.lastname: Belmonte
authors.forename: Giovanni
authors.initials: G
authors.lastname: Aragona
authors.forename: Gianni
authors.initials: G
authors.lastname: Imperiali
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Forte
authors.forename: Fabio
authors.initials: F
authors.lastname: Monica
authors.forename: Nazario
authors.initials: N
authors.lastname: Caruso
authors.forename: Francesco
authors.initials: F
authors.lastname: Perri
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012008:Recurrence
chemical_list: D054328:Proton Pump Inhibitors