Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful endoscopic therapy.
BACKGROUND
High dose intravenous proton pump inhibitor after endoscopic therapy for peptic ulcer bleeding has been recommended as adjuvant therapy. Whether oral proton pump inhibitor can replace intravenous proton pump inhibitor in this setting is unknown. This study aims to compare the clinical efficacy of oral and intravenous proton pump inhibitor after endoscopic therapy.


METHODS
Patients with high-risk bleeding peptic ulcers after successful endoscopic therapy were randomly assigned as oral lansoprazole or intravenous esomeprazole group. Primary outcome of the study was re-bleeding rate within 14 days. Secondary outcome included hospital stay, volume of blood transfusion, surgical intervention and mortality within 1 month.


RESULTS
From April 2010 to Feb 2011, 100 patients were enrolled in this study. The re-bleeding rates were 4% (2/50) in the intravenous group and 4% (2/50) in the oral group. There was no difference between the two groups with regards to the hospital stay, volume of blood transfusion, surgery or mortality rate. The mean duration of hospital stay was 1.8 days in the oral lansoprazole group and 3.9 days in the intravenous esomeprazole group (p > 0.01).


CONCLUSIONS
Patients receiving oral proton pump inhibitor have a shorter hospital stay. There is no evidence of a difference in clinical outcomes between oral and intravenous PPI treatment. However, the study was not powered to prove equivalence or non-inferiority. Future studies are still needed.


BACKGROUND
NCT01123031.
Department of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan.
Hsu-Heng
HH
Yen
Chia-Wei
CW
Yang
Wei-Wen
WW
Su
Maw-Soan
MS
Soon
Shun-Sheng
SS
Wu
Hwai-Jeng
HJ
Lin
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001803:Blood Transfusion; D004724:Endoscopy; D064098:Esomeprazole / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D064747:Lansoprazole; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy / Q000601:surgery; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control* / Q000601:surgery; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D055502:Secondary Prevention; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D064098:Esomeprazole