High dose intravenous proton pump inhibition decrease both re-bleeding and mortality in high-risk patients with acute peptic ulcer bleeding: A series of meta-analyses

Peptic ulcer bleeding is a common medical emergency and still a potentially fatal condition. It is the best managed using a multidisciplinary approach by a team with medical, endoscopic and surgical expertise. Appropriate resuscitation followed by early endoscopy for diagnosis and treatment are of major importance in these patients. Endoscopy is recommended within 24 h of presentation. Endoscopic therapy is indicated for patients with high-risk stigmata, in particular those with active bleeding and visible vessels. A combination of proton pump inhibitors and endoscopic therapy (using a combination of injection and mechanical hemostasis) offers the best chance of hemostasis for those with active bleeding ulcers. The application of an ulcer-covering hemospray is a new promising tool. High dose proton pump inhibitors should be administered intravenously for 72 h in high-risk patients. Helicobacter pylori should be tested for in all patients with peptic ulcer bleeding and eradicated if positive

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Double oral esomeprazole after a 3-day intravenous esomeprazole infusion reduces recurrent peptic ulcer bleeding in high-risk patients: a randomised controlled study

Gut ◽

10.1136/gutjnl-2013-306531 ◽

2014 ◽

Vol 63 (12) ◽

pp. 1864-1872 ◽

Cited By ~ 17

Author(s):

Hsiu-Chi Cheng ◽

Chung-Tai Wu ◽

Wei-Lun Chang ◽

Wei-Chun Cheng ◽

Wei-Ying Chen ◽

...

Keyword(s):

Peptic Ulcer ◽

High Risk ◽

Ulcer Bleeding ◽

Controlled Study ◽

Peptic Ulcer Bleeding ◽

High Risk Patients ◽

Randomised Controlled Study ◽

Risk Patients ◽

Randomised Controlled

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A Real World Report on Intravenous High-Dose and Non-High-Dose Proton-Pump Inhibitors Therapy in Patients with Endoscopically Treated High-Risk Peptic Ulcer Bleeding

Gastroenterology Research and Practice ◽

10.1155/2012/858612 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Lung-Sheng Lu ◽

Sheng-Chieh Lin ◽

Chung-Mou Kuo ◽

Wei-Chen Tai ◽

Po-Lin Tseng ◽

...

Keyword(s):

Peptic Ulcer ◽

High Risk ◽

Proton Pump ◽

Real World ◽

Case Control ◽

Ulcer Bleeding ◽

Control Group ◽

High Dose ◽

Peptic Ulcer Bleeding ◽

Treatment Control

Background and Study Aims. The optimal dose of intravenous proton-pump inhibitor (PPI) therapy for the prevention of peptic ulcer (PU) rebleeding remains controversial. This study aimed to understand the real world experiences in prescribing high-dose PPI and non-high-dose PPI for preventing rebleeding after endoscopic treatment of high-risk PU.Patients and Methods. A total of 220 subjects who received high-dose and non-high-dose pantoprazole for confirmed acute PU bleeding that were successfully treated endoscopically were enrolled. They were divided into rebleeding (n=177) and non-rebleeding groups (n=43). Randomized matching of the treatment-control group was performed. Patients were randomly selected for non-high-dose and high-dose PPI groups (n=44in each group).Results. Univariate analysis showed, significant variables related to rebleeding were female, higher creatinine levels, and higher Rockall scores (≧6). Before case-control matching, the high-dose PPI group had higher creatinine level, higher percentage of shock at presentation, and higher Rockall scores. After randomized treatment-control matching, no statistical differences were observed for rebleeding rates between the high-dose and non-high-dose groups after case-control matching.Conclusion. This study suggests that intravenous high-dose pantoprazole may not be superior to non-high-dose regimen in reducing rebleeding in high-risk peptic ulcer bleeding after successful endoscopic therapy.

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