Baseline Proton Pump Inhibitor Use to Predict Need for Clinical Intervention for Patients with Nonvariceal Upper Gastrointestinal Tract Bleeding

Abstract

Purpose: Early endoscopy (within 24 hour of admission) has been advocated for the management of acute upper gastrointestinal bleeding (UGIB) and identifies many patients who may be safely treated without hospitalization. Proton Pump inhibitor (PPI) therapy is associated with significant expense and there is little evidence to support that PPI usage prior to presentation with UGIB (baseline PPI use) leads to less likely need for early clinical intervention. We hypothesized that those patients taking PPIs prior to admission will be less likely need early endoscopy when they are admitted for overt UGIB. Methods: A retrospective chart review was performed from January 2005 to December 2008 on patients presenting for endoscopic evaluation of overt UGIB defined as hematemesis, bloody nasogastric tube lavage, melena, hematochezia +/- acute hematocrit drop or orthorstasis. Patients who had UGIB secondary to varices, portal hypertensive gastropathy, and patients who had no significant finding on upper endoscopy were excluded. Eligible patients were assigned to two groups: patients who were taking a PPI prior to admission and patients who were not taking a PPI prior to admission. Logistic regression analysis was performed using treatment with a PPI within the last 4 weeks prior to admission as a predictor variable in both groups. Peptic ulcer disease, erosions, esophagitis, gastritis, duodenitis and arterial bleeding were considered to be a cause of non-variceal UGIB. Results: 843 consecutive patients were referred for endoscopic evaluation of UGIB, 658 patients met the inclusion criteria. There were 110 patients who were on PPI prior to admission and 548 patients who were not on PPI prior to admission. Demographic and clinical data are shown in Table.Table: No Caption available.Conclusion: Patients taking a PPI prior to admission were less likely to have an early endoscopy (p=0.01) when admitted for overt UGIB.