Proton Pump Inhibitors After Endoscopic Hemostasis in Patients With Peptic Ulcer Bleeding

Background: Peptic ulcer bleeding is a common and potentially fatal condition. For patients with bleeding peptic ulcers that display major endoscopic stigmata of recent hemorrhage, a combination of endoscopic and pharmacologic therapy is the current standard management. Objective: To show our experience with management of peptic ulcer bleeding. Patients: Patients who presented with gastrointestinal bleeding caused by peptic ulcer or recent history (<24 h before presentation) of hematemesis and/or melena admitted to our hospital emergency departments, and patients whose ulcer hemorrhage started after hospitalization for an unrelated medical or surgical condition. Methods: Patients with actively bleeding ulcers and those with nonbleeding visible vessel or adherent clot were treated with epinephrine injection and/or endoscopic hemoclips, and randomized to receive intravenous pantoprasole according to the continuous regimen (dose of 5 x 40 mg in continuous infusion of 8 mg/h for 72 h) or the standard regimen (40 mg bolus of PPi twice daily for 3 days). After the infusion, all patients were given 40 mg PPi twice daily orally. The primary end point was the in-hospital rebleeding rate, as discovered by the repeated endoscopy. Results: Bleeding recurred in 5 of 34 patients (14.7%) receiving the intensive regimen, and in 8 of 35 (22.8%) patients receiving the standard regimen. Hemoglobin (g/l) rate in standard regimen group was 93.5 ± 23.8, and in intensive regimen group 106.6 ± 22.4 (P = 0,042). Mean units of blood transfused for all patients in group were 71.8 ± 45.8 in the intensive and 45.3 ± 50.2 in the standard regimen group (P=0.0257). The duration of hospital stay was 6.4 ± 2.8 in standard group and 5.8 ± 2.8 in the intensive group (P=0.40). Conclusions: in patients with bleeding peptic ulcers with successful endoscopic hemostasis the standard PPi regimen had advantage on transfusion requirements, but no advantage with respect to in-hospital rates of rebleeding rates, need for surgery, length of hospital stay, or death, which corresponds with recent studies.