Efficacy of an intravenous proton pump inhibitor after endoscopic therapy with epinephrine injection for peptic ulcer bleeding in patients with uraemia: a case-control study.
BACKGROUND
Patients with peptic ulcer bleeding and uraemia are prone to re-bleeding.


OBJECTIVE
To compare the efficacy of an intravenous proton pump inhibitor in treating peptic ulcer bleeding in patients with uraemia and those without uraemia.


METHODS
High-risk peptic ulcer bleeding patients received endoscopic therapy with epinephrine (adrenaline) injection plus intravenous omeprazole (40 mg bolus followed by 40 mg infusion every 12 h) for 3 days. Re-bleeding, volume of blood transfusion, hospital stay, need for surgery, and mortality were analysed.


RESULTS
The uraemic group had similar 7-day re-bleeding rate (6/42, 14.29% vs. 6/46, 13.04%, P = 0.865) to that of non-uraemic patients, but more re-bleeding episodes beyond 7 days (4/42, 9.52% vs. 0/46, 0%, P = 0.032, OR [95% CI] = 1.105 [1.002-1.219]) and all-cause mortality (4/42 vs. 0/46 P = 0.032, OR [95% CI] = 1.105 [1.002-1.219]). The uraemic group also had more units of blood transfusion after endoscopic therapy (mean +/- s.d. 4.33 +/- 3.35 units vs. 2.15 +/- 1.65 units, P < 0.001), longer hospital stay (mean +/- s.d. 8.55 +/- 8.12 days vs. 4.11 +/- 1.60 days, P < 0.001) and complications during hospitalization (9/42 vs. 0/46, P = 0.001, OR [95% CI] = 1.273 [1.087-1.490]).


CONCLUSIONS
Endoscopic therapy with epinephrine injection plus an intravenous proton pump inhibitor can offer protection against early re-bleeding in uraemic patients with peptic ulcer bleeding, but has a limited role beyond 7 days.
Tseng
G-Y
GY
Division of Gastroenterology, Department of Medicine, Ton-Yen General Hospital, Hsin-Chu, Taiwan.
Fang
C-T
CT
Lin
H-J
HJ
Yang
H-B
HB
Tseng
G-C
GC
Wang
P-C
PC
Liao
P-C
PC
Cheng
Y-T
YT
Huang
C-H
CH
D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001803:Blood Transfusion; D016022:Case-Control Studies; D004334:Drug Administration Schedule; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage; D010437:Peptic Ulcer / Q000628:therapy*; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control* / Q000628:therapy; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012044:Regression Analysis; D016896:Treatment Outcome; D014511:Uremia / Q000150:complications / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D014662:Vasoconstrictor Agents; D009853:Omeprazole; D004837:Epinephrine