title: Proton pump inhibitors after endoscopic hemostasis in patients with peptic ulcer bleeding.
abstract: BACKGROUND
  Peptic ulcer bleeding is a common and potentially fatal condition. For patients with bleeding peptic ulcers that display major endoscopic stigmata of recent hemorrhage, a combination of endoscopic and pharmacologic therapy is the current standard management.
  
  
  OBJECTIVE
  To show our experience with management of peptic ulcer bleeding.
  
  
  METHODS
  Patients who presented with gastrointestinal bleeding caused by peptic ulcer or recent history (< 24 h before presentation) of hematemesis and/or melena admitted to our hospital emergency departments, and patients whose ulcer hemorrhage started after hospitalization for an unrelated medical or surgical condition.
  
  
  METHODS
  Patients with actively bleeding ulcers and those with nonbleeding visible vessel or adherent clot were treated with epinephrine injection and/or endoscopic hemoclips, and randomized to receive intravenous pantoprasole according to the continuous regimen (dose of 5 x 40 mg in continuous infusion of 8 mg/h for 72 h) or the standard regimen (40 mg bolus of PPI twice daily for 3 days). After the infusion, all patients were given 40 mg PPI twice daily orally. The primary end point was the in-hospital rebleeding rate, as discovered by the repeated endoscopy.
  
  
  RESULTS
  Bleeding recurred in 5 of 34 patients (14.7%) receiving the intensive regimen, and in 8 of 35 (22.8%) patients receiving the standard regimen. Hemoglobin (g/l) rate in standard regimen group was 93.5 +/- 23.8, and in intensive regimen group 106.6 +/- 22.4 (P = 0.042). Mean units of blood transfused for all patients in group were 71.8 +/- 45.8 in the intensive and 45.3 +/- 50.2 in the standard regimen group (P = 0.0257). The duration of hospital stay was 6.4 +/- 2.8 in standard group and 5.8 +/- 2.8 in the intensive group (P = 0.40).
  
  
  CONCLUSIONS
  In patients with bleeding peptic ulcers with successful endoscopic hemostasis the standard PPI regimen had advantage on transfusion requirements, but no advantage with respect to in-hospital rates of rebleeding rates, need for surgery, length of hospital stay, or death, which corresponds with recent studies.
authors.affiliation: Clinical Centre University of Sarajevo, Department of Gastroenterology and Hepatology, Sarajevo, Bosnia and Herzegovina. gastro@bih.net.ba
authors.forename: Rusmir
authors.initials: R
authors.lastname: Mesihovic
authors.forename: Nenad
authors.initials: N
authors.lastname: Vanis
authors.forename: Amila
authors.initials: A
authors.lastname: Mehmedovic
authors.forename: Srdjan
authors.initials: S
authors.lastname: Gornjakovic
authors.forename: Mehmed
authors.initials: M
authors.lastname: Gribajcevic
mesh_terms: D000284:Administration, Oral; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control* / Q000628:therapy; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D055502:Secondary Prevention
chemical_list: D054328:Proton Pump Inhibitors