title: Optimal duration of proton pump inhibitor in the treatment of endoscopic submucosal dissection-induced ulcers: a retrospective analysis and prospective validation study.
abstract: BACKGROUND
  The optimal duration of proton pump inhibitor (PPI) use in the treatment of endoscopic submucosal dissection (ESD)-induced ulcers has not been well defined.
  
  
  OBJECTIVE
  The aim of study was to determine the optimal duration of PPI treatment for ESD-induced gastric ulcers.
  
  
  METHODS
  A total of 333 patients who underwent ESD were included in this retrospective analysis and prospective randomized validation. Medical records and endoscopic images for the 221 patients in our ESD-database were reviewed retrospectively. Based on the results of the retrospective analysis, 112 patients with ESD-induced ulcers over 40 mm were randomly assigned to two groups (4- or 8-week course of Lansoprazole 30 mg). Main outcome measurements were to assess the healing-related factors of post-ESD ulcers (retrospective analysis) and to compare complete mucosal healing rate in large (≥ 40 mm) ESD-induced ulcers according to the duration of PPI treatment (prospective validation).
  
  
  RESULTS
  Multivariate logistic regression from a retrospective analysis showed that a duration of PPI treatment <8 weeks and a post-ESD ulcer ≥ 40 mm in size were associated with incomplete healing. In a prospective validation, the rate of complete healing in the 8-week PPI group was significantly higher than that of the 4-week PPI group for a large (≥ 40 mm) ESD-induced ulcer at 8 weeks follow-up (83.3 vs. 42.6%, P < 0.01).
  
  
  CONCLUSIONS
  The optimal duration of PPI treatment varies based on the initial ulcer size. Patients with an ESD-induced ulcer over 40 mm should be treated with an 8-week course of PPIs.
authors: Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Korea.
authors: Suck-Ho
authors: SH
authors: Lee
authors: Chang Kyun
authors: CK
authors: Lee
authors: Il-Kwun
authors: IK
authors: Chung
authors: Yun Suk
authors: YS
authors: Shim
authors: Tae Hoon
authors: TH
authors: Lee
authors: Sae Hwan
authors: SH
authors: Lee
authors: Hong-Soo
authors: HS
authors: Kim
authors: Sang-Heum
authors: SH
authors: Park
authors: Sun-Joo
authors: SJ
authors: Kim
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000368:Aged; D004210:Dissection / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods; D004791:Enzyme Inhibitors / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D064747:Lansoprazole; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D013276:Stomach Ulcer / Q000188:drug therapy* / Q000209:etiology; D014945:Wound Healing / Q000187:drug effects
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D064747:Lansoprazole