scholarly journals Comparison of Oral versus Intravenous Proton Pump Inhibitors in Preventing Re-bleeding from Peptic Ulcer after Successful Endoscopic Therapy

2018 ◽  
Vol 10 (4) ◽  
pp. 236-241
Author(s):  
Seyed Mohammad Valizadeh Toosi ◽  
Ahmad Reza Elahi Vahed ◽  
Iradj Maleki ◽  
Zohreh Bari
Keyword(s):  
Peptic Ulcer ◽  
High Risk ◽  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Proton Pump ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
High Dose ◽  
Dose Oral ◽  
Upper Gastrointestinal

BACKGROUND Proton pump inhibitors (PPIs) are now widely prescribed for the management of patients with acute upper gastrointestinal bleeding; although its optimal dose and route of administration has remained a controversial issue. The aim of this study was to assess the clinical effectiveness of high dose oral versus intravenous (IV) PPI after successful endoscopic therapy in patients with bleeding peptic ulcer disease. METHODS 178 patients with active upper gastrointestinal bleeding due to a peptic ulcer with stigmata of high risk for re-bleeding entered the study. After successful endoscopic hemostasis, they were randomized to receive either high dose oral pantoprazole (80 mg stat and 80 mg twice daily for 3 days) or high dose intravenous pantoprazole (80 mg IV infusion within 30 minutes and 8 mg per hour for 3 days). After the 3rd day, the patients in both groups received oral pantoprazole 40 mg twice daily for one month. The end points were comparing the rate of re-bleeding or mortality, and the need for blood transfusion or surgery during the first month between the two groups. RESULTS There were not significant statistical differences between the two groups in the volume of blood transfusion, mean duration of hospital stay, need to surgery, or mortality rates. However, the rates of re-bleeding were 2.3% (2:88) in the IV group and 3.3% (3:90) in the oral group (p = 0.6). CONCLUSION According to our findings, it seems that high dose oral PPI can be a good alternative to high dose IV PPI in patients with bleeding peptic ulcer who are at high risk of re-bleeding. Due to the lower cost and the availability of oral PPIs, their use can be economically much more affordable.

scholarly journals Management of acute upper gastrointestinal bleeding

BMJ ◽  
2019 ◽  
pp. l536 ◽  
Author(s):  
Adrian J Stanley ◽  
Loren Laine
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Variceal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Ulcer Bleeding ◽  
Vasoactive Drugs ◽  
Upper Gastrointestinal

Abstract Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 70-80 g/L are recommended. After resuscitation is initiated, proton pump inhibitors (PPIs) and the prokinetic agent erythromycin may be administered, with antibiotics and vasoactive drugs recommended in patients who have cirrhosis. Endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices) and for high risk non-variceal bleeding (for example, injection, thermal probes, or clips for lesions with active bleeding or non-bleeding visible vessel). Patients who require endoscopic therapy for ulcer bleeding should receive high dose proton pump inhibitors after endoscopy, whereas those who have variceal bleeding should continue taking antibiotics and vasoactive drugs. Recurrent ulcer bleeding is treated with repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery. Recurrent variceal bleeding is generally treated with transjugular intrahepatic portosystemic shunt. In patients who require antithrombotic agents, outcomes appear to be better when these drugs are reintroduced early.

scholarly journals A Canadian Clinical Practice Algorithm for the Management of Patients with Non-Variceal Upper Gastrointestinal Bleeding

2004 ◽  
Vol 18 (10) ◽  
pp. 605-609 ◽  
Author(s):  
Alan Barkun ◽  
Carlo A Fallone ◽  
Naoki Chiba ◽  
Marty Fishman ◽  
Nigel Flook ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Gastrointestinal Bleeding ◽  
Proton Pump ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Current Evidence ◽  
High Dose ◽  
Proton Pump Inhibition ◽  
Early Endoscopy ◽  
Upper Gastrointestinal

AIM:To use current evidence-based recommendations to provide a user-friendly clinical algorithm for the management of upper gastrointestinal bleeding, adapted to the Canadian environment.METHODS:A multidisciplinary consensus group of 25 participants representing 11 national societies used a seven-step approach to develop recommendations according to accepted standards. Sources of data included narrative and systematic reviews as well as published and new meta-analyses. A small writing subgroup subsequently created the algorithm.RESULTS:Recommendations emphasize appropriate initial resuscitation of the patient and a multidisciplinary approach to clinical risk stratification that determines the need for early endoscopy. Early endoscopy allows safe and prompt discharge of selected patients classified as low risk. Endoscopic hemostasis is reserved for patients with high-risk endoscopic lesions. Although monotherapy with injection or thermal coagulation is effective, the combination is superior to either treatment alone. High-dose intravenous proton-pump inhibition is recommended in patients who have undergone successful endoscopic therapy. Routine second-look endoscopy is not recommended. Patients with upper gastrointestinal bleeding secondary to ulcer disease should be tested and treated forHelicobacter pyloriinfection.CONCLUSIONS:This algorithm should facilitate appropriate risk stratification, use of endoscopic therapy and the appropriate utilization of proton-pump inhibition to optimize the care of patients with upper gastrointestinal bleeding. The algorithm should be customized to the resources of individual medical centres. Its application should be studied with appropriate outcomes recorded and validation performed.

scholarly journals Triaging patients with upper gastrointestinal bleeding: the utility of Glasgow-Blatchford score

2019 ◽  
Vol 8 (1) ◽  
pp. 42
Author(s):  
Namita Mohanty ◽  
Arjun Nataraj Kannan
Keyword(s):  
High Risk ◽  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Hospital Stay ◽  
Upper Gastrointestinal Bleeding ◽  
Positive Likelihood Ratio ◽  
Low Risk ◽  
P Value ◽  
Duration Of Hospital Stay ◽  
Upper Gastrointestinal

Background: Glasgow-Blatchford bleeding score (GBS), was developed to predict the need for hospital-based intervention (transfusion, endoscopic therapy or surgery) or death following upper gastrointestinal bleeding. Study evaluated the Glasgow Blatchford score’s (GBS) ability to identify high risk patients who needed blood transfusion in patients with UGI haemorrhage.Methods: A total of 270 cases admitted with upper gastrointestinal bleeding in the Medical ICU/Wards of MKCG Medical College were put on Blatchford scoring system and classified as those requiring (high risk = GBS >1) and not requiring blood transfusion (low risk) based on the score assigned on admission and a correlation between initial scoring and requirement of blood transfusion was done.Results: Units of blood transfusion required, the GBS and duration of hospital stay were significantly lower among the low risk group, all with p value <0.001. No blood transfusion was required in patients with GBS <3. There was significant correlation between GB score and requirement of blood transfusion (p <0.001) and duration of hospital stay (p <0.001). GBS had 100% sensitivity, negative predictive value and positive likelihood ratio, when a cut off of > 16 was used in predicting mortality.Conclusions: Patients presenting with Upper GI bleeding can be triaged in casualty with Glasgow Blatchford scoring. Patients with a low score of less than or equal to 3 can be safely discharged and reviewed on follow up thereby reducing admission, allowing more efficient use of hospital resources.

scholarly journals The management of the patient with non-variceal upper gastrointestinal bleeding: from evidence to clinical practice

2016 ◽  
Vol 11 ◽  
Author(s):  
Maddalena Zippi ◽  
Mariella Frualdo ◽  
Luciano Mucci ◽  
Marta Zanon ◽  
Chiara Marzano ◽  
...  
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
High Dose ◽  
Cardiovascular Risks ◽  
High Risk Patients ◽  
Epinephrine Injection ◽  
Risk Patients ◽  
Upper Gastrointestinal

A multidisciplinary group of 7 experts developed this update and expansion of the recommendations on the management of acute non-variceal upper gastrointestinal bleeding (NVUGIH) from guidelines published from 2013. The Appraisal of Guidelines for Research and Evaluation (AGREE) process and independent ethics protocols were used. Sources of data included original and published systematic reviews. Recommendations emphasize early risk stratification, by using validated prognostic scales, and early endoscopy (within 24 hours). Endoscopic hemostasis remains indicated for high-risk lesions, whereas data support attempts to dislodge clots with hemostatic, pharmacologic, or combination treatment of the underlying stigmata. Clips or thermo-coagulation, alone or with epinephrine injection, are effective methods. Second-look endoscopy may be useful in selected high-risk patients, but is not routinely recommended. Intravenous high-dose PPI therapy after successful endoscopic hemostasis decreases both rebleeding and mortality in patients with high-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 72 hours after endoscopic hemostasis. For patients with UGIH who require a nonsteroidal anti-inflammatory drug, a PPI is preferred to reduce the rebleeding. Patients with NVUGIH needing secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA) again as soon as cardiovascular risks outweigh gastrointestinal risks (usually within 7 days).

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