title: Intravenous non-high-dose pantoprazole is equally effective as high-dose pantoprazole in preventing rebleeding among low risk patients with a bleeding peptic ulcer after initial endoscopic hemostasis.
abstract: BACKGROUND
  Many studies have shown that high-dose proton-pumps inhibitors (PPI) do not further reduce the rate of rebleeding compared to non-high-dose PPIs but we do not know whether intravenous non-high-dose PPIs reduce rebleeding rates among patients at low risk (Rockall score < 6) or among those at high risk, both compared to high-dose PPIs. This retrospective case-controlled study aimed to identify the subgroups of these patients that might benefit from treatment with non-high-dose PPIs.
  
  
  METHODS
  Subjects who received high dose and non-high-dose pantoprazole for confirmed acute PU bleeding at a tertiary referral hospital were enrolled (n = 413). They were divided into sustained hemostasis (n = 324) and rebleeding groups (n = 89). The greedy method was applied to allow treatment-control random matching (1:1). Patients were randomly selected from the non-high-dose and high-dose PPI groups who had a high risk peptic ulcer bleeding (n = 104 in each group), and these were then subdivided to two subgroups (Rockall score ≥ 6 vs. < 6, n = 77 vs. 27).
  
  
  RESULTS
  An initial low hemoglobin level, serum creatinine level, and Rockall score were independent factors associated with rebleeding. After case-control matching, the significant variables between the non-high-dose and high-dose PPI groups for a Rockall score ≥ 6 were the rebleeding rate, and the amount of blood transfused. Case-controlled matching for the subgroup with a Rockall score < 6 showed that the rebleeding rate was similar for both groups (11.1% in each group).
  
  
  CONCLUSIONS
  Intravenous non-high-dose pantoprazole is equally effective as high-dose pantoprazole when treating low risk patients with a Rockall sore were < 6 who have bleeding ulcers and high-risk stigmata after endoscopic hemostasis.
authors.affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gang Memorial Hospital, 123 Ta-Pei Road, Niaosung Hsiang, Kaohsiung City 833, Taiwan.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Liang
authors.forename: Jyong-Hong
authors.initials: JH
authors.lastname: Lee
authors.forename: Yuan-Hung
authors.initials: YH
authors.lastname: Kuo
authors.forename: Keng-Liang
authors.initials: KL
authors.lastname: Wu
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chiu
authors.forename: Yeh-Pin
authors.initials: YP
authors.lastname: Chou
authors.forename: Ming-Luen
authors.initials: ML
authors.lastname: Hu
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Tai
authors.forename: King-Wah
authors.initials: KW
authors.lastname: Chiu
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.forename: Seng-Kee
authors.initials: SK
authors.lastname: Chuah
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D016558:Hemostasis, Endoscopic; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000077402:Pantoprazole; D010438:Peptic Ulcer Hemorrhage / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D055502:Secondary Prevention
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D006454:Hemoglobins; D054328:Proton Pump Inhibitors; D003404:Creatinine; D000077402:Pantoprazole