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109 INTRAVENOUS PROTON PUMP INHIBITION UTILIZATION AND PRESCRIBING PATTERNS ESCALATION: A COMPARISON BETWEEN EARLY AND PRESENT TRENDS IN USE JK Law1, CN Andrews2, R Enns1 BACKGROUND: Intravenous proton pump inhibitors (IV PPI) are commonly used after endoscopic evaluation of patients with high-risk endoscopic stigmata (HRES) in the setting of nonvariceal upper gastrointestinal bleeding (NVUGIB). While this is the primary proven indication of this medication, there appears to be an expansion of indications of this drug class at our centre over the past few years.
1Division of Gastroenterology, St Paul's Hospital, Vancouver British Columbia; 2Division of Gastroenterology and Hepatology Mayo Clinic, Rochester, Minnesota, USA
METHODS: A review of all consecutive patients receiving IV PPI (pantoprazole) while in hospital between two study periods; an early period when the drug was placed on hospital formulary restricted to gastroenterology service, and a late period when it was an unrestricted medication. Demographic data, risk factors for bleeding, comorbidities, indication and duration of treatment, progression to endoscopy and endoscopic findings and intervention were noted for each patient.
RESULTS: Over a span of 810 days in the early period, 217 patients (67.30% male, mean age 61.96 years) received IV pantoprazole on 218 occasions compared with 516 patients (65.31% male; P=0.61; mean age 61.67 years; P=0.83) in the later period over a span of 365 days on 613 occasions. In the early group, 93.12% of 217 patients received IV PPI for NVUGIB compared with 56.12% of 516 patients in the later group (P<0.0001) with 18% of patients receiving IV PPI for NPO status and 13% for abdominal pain in the later group. One hundred fifty-three (70.18%) patients in the early group underwent upper endoscopy compared with 275 (44.86%) patients in the later group; 84 of these 153 patients (54.90%) were already on IV PPI at the time of endoscopy in the early group compared with 253 (92.00%; P<0.0001) in the later group.
CONCLUSIONS: IV PPI use has escalated over the past two years at our hospital with apparent expansion of the indications for its use. It is being prescribed in patients before endoscopy with fewer patients noted to have HRES on endoscopy. Appropriate education and further investigations into the use of this medication may be necessary to encourage ideal utilization.