title: High Dose versus Low Dose Intravenous Pantoprazole in Bleeding Peptic Ulcer: A Randomized Clinical Trial.
abstract: BACKGROUND The appropriate dose of proton pump inhibitors for treatment of patients with upper (GI) bleeding remains controversial. This study compares high-dose versus low-dose intravenous proton pump inhibitor (PPI) infusion for prevention of GI bleeding complications. METHODS A total of 166 patients with bleeding peptic ulcers underwent therapeutic endoscopy using concomitant therapy by argon plasma coagulation (APC) and diluted epinephrine injection. Patients were randomly divided into two groups: high-dose pantoprazole (80 mg bolus, 8 mg per hour) and low-dose pantoprazole (40 mg bolus, 4 mg per hour) infused for three days. Initial outcomes were rebleeding, need for surgery, hemoglobin drop more than two units, and hospitalization for more than five days. Secondary outcome included mortality rate. RESULTS Overall, 166 patients (83 patients per group) enrolled in the study. The average age of patients in the high-dose group was 59.5±15.6 years and 52.3±13.3 years in the low-dose group (p=0.58). Males comprised 69.7% of patients. In the high-dose group, the mean number of units of transfused blood was 3.3±1.71 and in the low-dose group, it was 2.82±1.73 (p=0.50). There were 36 (43.37%) patients in the high-dose group and 40 (48.19%) in the low-dose group who were hospitalized for more than 5 days (p=0.53). Rebleeding was observed in 27 (32.53%) patients in the high-dose group and in 21 (25.30%) in the low-dose group (p=0.30). There were no significant differences observed in drop in hemoglobin of more than two units (p=0.15), mortality (p=0.99) and surgery (p=0.75) between the two groups. CONCLUSION For controlling peptic ulcer bleeding, there is no difference between high dose and low dose pantoprazole infusion.
authors.affiliation: Research Institute for Infectious Diseases of the Digestive System, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran ; Division of Gastroenterology and Hepatology,Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran.
authors.forename: Abdol Rahim
authors.initials: AR
authors.lastname: Masjedizadeh
authors.affiliation: Research Institute for Infectious Diseases of the Digestive System, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran ; Division of Gastroenterology and Hepatology,Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran.
authors.forename: Eskandar
authors.initials: E
authors.lastname: Hajiani
authors.affiliation: Research Institute for Infectious Diseases of the Digestive System, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran ; Division of Gastroenterology and Hepatology,Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran.
authors.forename: Pezhman
authors.initials: P
authors.lastname: Alavinejad
authors.affiliation: Research Institute for Infectious Diseases of the Digestive System, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran ; Division of Gastroenterology and Hepatology,Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran.
authors.forename: Seyed Jalal
authors.initials: SJ
authors.lastname: Hashemi
authors.affiliation: Research Institute for Infectious Diseases of the Digestive System, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran ; Division of Gastroenterology and Hepatology,Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran.
authors.forename: Ali Akbar
authors.initials: AA
authors.lastname: Shayesteh
authors.affiliation: Department of Internal Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran.
authors.forename: Noordin
authors.initials: N
authors.lastname: Jamshidian
keywords: Bleeding peptic ulcer; Endoscopy; Pantoprazole
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