Effect of intravenous proton pump inhibitor regimens and timing of endoscopy on clinical outcomes of peptic ulcer bleeding.
OBJECTIVE
The most effective schedule of proton pump inhibitor (PPI) administration and the optimal timing of endoscopy in acute peptic ulcer bleeding remain uncertain. The aim of this study was to determine the most efficient PPI regimen and optimal timing of endoscopy.


METHODS
Consecutive patients with suspected bleeding peptic ulcers were enrolled and randomized to receive either a standard regimen or a high-dose intensive intravenous regimen. Only patients with bleeding peptic ulcers diagnosed at initial endoscopy continued the study. High-risk patients received endoscopic hemostasis. The primary outcome measure of recurrent bleeding was compared between the two dosage regimens and between early and late endoscopy. Secondary outcome measures compared included need for endoscopic treatment, blood transfusion, hospital stay, surgery and mortality.


RESULTS
A total of 875 patients completed the study. Recurrent bleeding occurred in 11.0% in the standard regimen group, statistically higher than that in the intensive regimen group (6.4%, P=0.02). Mean units of blood transfused and duration of hospital stay were also higher in the standard regimen group (P<0.001 for each compared to intensive regimen group). However, no significant differences were noted between the two groups in the need for endoscopic hemostasis, need for surgery, and mortality. Recurrence of bleeding was similar between the early and late endoscopy groups. Units of blood transfused and length of hospital stay were both significantly reduced with early endoscopy.


CONCLUSIONS
High-dose PPI infusion is more efficacious in reducing rebleeding rate, blood transfusion requirements and hospital stay. Early endoscopy is safe and more effective than late endoscopy.
State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Na
N
Liu
Lili
L
Liu
Hongbo
H
Zhang
Prakash Chandra
PC
Gyawali
Dexin
D
Zhang
Liping
L
Yao
Yan
Y
Yang
Kaichun
K
Wu
Jie
J
Ding
Daiming
D
Fan
D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D016099:Endoscopy, Gastrointestinal; D064098:Esomeprazole / Q000008:administration & dosage; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control* / Q000628:therapy; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors
D054328:Proton Pump Inhibitors; D009853:Omeprazole; D064098:Esomeprazole