234 The Effects of Pantoprazole IV Drip Versus Pantoprazole IV Bolus on Stigmata of Recent Hemorrhage Among Patients With Nonvariceal Upper Gastrointestinal Bleeding

Abstract

Gastrointestinal hemorrhage caused by peptic ulcer disease is still one of the most common GI diseases requiring emergency treatment. UGI endoscopy has shown that a bleeding peptic ulcer usually has stigmata of recent hemorrhage indicating the site of the bleeding. Studies have shown that a neutral gastric pH is critical for the stability of clots noted over the bleeding ulcer. This study was done to determine whether PPI IV bolus followed by continuous infusion of 8mh/hr in 72 hours in acute nonvariceal upper gastrointestinal bleeding shows better therapeutic effect than PPI IV bolus of 40mg every 12 hours for 3 days in terms of stigmata of recent hemorrhage as shown in endoscopy done within 48-72 hours after admission as the primary outcome. Secondary outcomes are as follows; rebleeding, need for endoscopic therapy, number of hospital days, need for surgery and mortality. Consecutive patients with upper gastrointestinal bleeding admitted were randomly assigned to receive either Pantoprazole 80mg IV bolus followed by Pantoprazole continuous IV drip at 8mg/hr for 72 hours or Pantoprazole 40mg every 12 hours IV for 3 days. Patients were then scheduled for UGI endoscopy which was done within 48-72 hours. Stigmata of Recent Hemorrhage on initial endoscopy were noted. The rate of rebleeding, number of blood units transfused, number of hospital days, as well as mortality were also noted. Over an 8-month period, total of 193 patients were evaluated; but only 60 were included. Patients were randomly assigned to two groups, Group A Pantoprazole 80mg intravenous bolus injection followed by continuous infusion of 8 mg per hour for 72 hours and Group B Pantoprazole 40mg every 12 hours intravenous for 3 days. There were no significant differences between the two groups in terms of age, smoking history, use of NSAIDS, and co-morbidity. There were more male patients enrolled in Group A The study showed that there was no significant difference in the stigmata of recent hemorrhage (Forrest classification), rate of rebleeding, need for surgey and as well as mortality. However more blood units were transfused in Group A. This study showed that there was no significant difference on the stigmata of recent hemorrhage of bleeding peptic ulcers seen on initial endoscopy after Pantoprazole IV bolus followed by continuous IV drip compared to Pantoprazole IV bolus. There was also no significant difference in the rate of rebleeding, need for surgery, number of hospital days as well as mortality. Since Pantoprazole IV bolus is as effective as Pantoprazole IV bolus followed by continuous IV drip this implies a significant cost saving in proton pump inhibitor therapy for nonvariceal upper gastrointestinal bleeding.Table ICharacteristics of Patients included in the StudyAge in YearsGroup AGroup B64.43 ± 14.8556.83 ± 16.75.068Sex(Males)63%(24)37%(14).007Smoking History %65.2%34.8%.063Use of NSAIDs%53.3%46.7%.606Baseline Disease% Comorbidities45%45%.346 Open table in a new tab Table IIStigmata of Recent HemorrhageSRH* (Forrest)Group AGroup B.0681a (%) (n)1.7% (1)0% (0).0681b (%) (n)1.7 % (1)0 % (0)2a (%) (n)8.3% (5)1.7% (1)2b (%) (n)3.3 % (2)10% (6)2c (%) (n)8.3% (5)1.7% (1)3 (%) (n)26.7% (16)36.7% (22) Open table in a new tab