title: Outcomes of peptic ulcer bleeding following treatment with proton pump inhibitors in routine clinical practice: 935 patients with high- or low-risk stigmata.
abstract: OBJECTIVE
  To assess rates of further bleeding, surgery and mortality in patients hospitalized owing to peptic ulcer bleeding.
  
  
  METHODS
  Consecutive patients hospitalized for peptic ulcer bleeding and treated with a proton pump inhibitor (PPI) (esomeprazole or pantoprazole) were identified retrospectively in 12 centers in Spain. Patients were included if they had high-risk stigmata (Forrest class Ia-IIb, underwent therapeutic endoscopy and received intravenous PPI ≥120 mg/day for ≥24 h) or low-risk stigmata (Forrest class IIc-III, underwent no therapeutic endoscopy and received intravenous or oral PPI [any dose]).
  
  
  RESULTS
  Of 935 identified patients, 58.3% had high-risk stigmata and 41.7% had low-risk stigmata. After endoscopy, 88.3% of high-risk patients and 22.1% of low-risk patients received intravenous PPI therapy at doses of at least 160 mg/day. Further bleeding within 72 h occurred in 9.4% and 2.1% of high- and low-risk patients, respectively (p < 0.001). Surgery to stop bleeding was required within 30 days in 3.5% and 0.8% of high- and low-risk patients, respectively (p = 0.007). Mortality at 30 days was similar in both groups (3.3% in high-risk and 2.3% in low-risk patients).
  
  
  CONCLUSIONS
  Among patients hospitalized owing to peptic ulcer bleeding and treated with PPIs, patients with high-risk stigmata have a higher risk of further bleeding and surgery, but not of death, than those with low-risk stigmata.
authors.affiliation: Servicio de Aparato Digestivo, Hospital Clínico, Universidad de Zaragoza, IIS Aragón , Zaragoza , Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
authors.forename: Patricia
authors.initials: P
authors.lastname: Carrera-Lasfuentes
authors.forename: Luis A
authors.initials: LA
authors.lastname: García-Rodríguez
authors.forename: Santiago
authors.initials: S
authors.lastname: García
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Arroyo-Villarino
authors.forename: Julio
authors.initials: J
authors.lastname: Ponce
authors.forename: Luis
authors.initials: L
authors.lastname: Bujanda
authors.forename: José L
authors.initials: JL
authors.lastname: Calleja
authors.forename: Mónica
authors.initials: M
authors.lastname: Polo-Tomas
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
authors.forename: Faust
authors.initials: F
authors.lastname: Feu
authors.forename: Angeles
authors.initials: A
authors.lastname: Perez-Aisa
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage; D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004381:Duodenal Ulcer / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D064098:Esomeprazole / Q000008:administration & dosage; D005260:Female; D016558:Hemostasis, Endoscopic; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole; D064098:Esomeprazole
keywords: peptic ulcer hemorrhage; pharmacoepidemiology; proton pump inhibitors; retrospective study