HOME
Return to Table of Contents
91 A COMPARISON OF INTRAVENOUS (IV) VERSUS ORAL PROTON PUMP INHIBITORS (PPIs) FOR PATIENTS WITH HIGH RISK ACUTE NONVARICEAL UPPER GI BLEEDING (ANVUGIB) LE Targownik, L Keyvani, SK Murthy, S Leeson BACKGROUND: The use of IV PPIs in patients with ANVUGIB following performance of endoscopic hemostasis is currently the standard of care. A 72 h course of IV PPI following performance of endoscopic hemostasis for high-risk lesions has been shown to decrease the risk of rebleeding when compared with placebo. However, providing PPIs intravenously is associated with high medication costs and the need for a continuous intravenous infusion may prolong hospital stays. High-dose oral proton pump inhibitors have also been proven to be efficacious in reducing the risk of rebleeding for high-risk patients. There are no direct comparisons of IV versus oral PPIs for ANVUGIB patients following endoscopic hemostasis.
Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba
METHODS: We performed a retrospective review of all patients who presented to one of two tertiary care hospitals in Winnipeg, Manitoba from 1999 to 2004 with a admitting diagnosis of ANVUGIB who underwent diagnostic upper endoscopy and performance of therapeutic hemostasis within 24 h of presentation. We separated the patients into one of two groups, based on whether they received intravenous PPIs following performance of endoscopy or they received oral PPIs only. The primary outcome measure was the development of any adverse outcome (in-hospital rebleeding, surgery, in-hospital mortality or readmission within 30 days for ANVUGIB). Other outcomes included the time to endoscopy, transfusion requirements both before endoscopy and after 24 h following the initial endoscopy and the length of hospital stay.
RESULTS: We identified 126 subjects who underwent therapeutic hemostasis of whom 43 received IV PPIs and 80 received oral PPI (3 received H2RAs only). There were no significant differences in baseline demographics, or severity of presentation by pre-endoscopic Rockall score. Patients receiving IV PPIs were nonsignificantly more likely have high-risk stigmata noted on endoscopy reports (76% vs 63%; P=0.12). There were no differences in the rates of adverse outcomes (24% IV PPI vs 17%; P>0.2), or likelihood of requiring a transfusion more than 24 h following initial endoscopy. (30% vs 25%; P>0.2). The overall length of hospital stay was comparable between the two groups.
CONCLUSIONS: IV PPIs to do not appear to provide any incremental benefit over oral PPIs for ANVUGIB patients undergoing endoscopic hemostasis for high-risk lesions. Prospective research needs to be performed to determine whether provision of oral PPIs is an acceptable substitute for high-risk ANVUGIB patients.
Unrestricted Grant from Altana Pharma