Abstract
BackgroundHigh dose intravenous proton pump inhibitor after endoscopic therapy for peptic ulcer bleeding has been recommended as adjuvant therapy. Whether oral proton pump inhibitor can replace intravenous proton pump inhibitor in this setting is unknown. This study aims to compare the clinical efficacy of oral and intravenous proton pump inhibitor after endoscopic therapy.MethodsPatients with high-risk bleeding peptic ulcers after successful endoscopic therapy were randomly assigned as oral lansoprazole or intravenous esomeprazole group. Primary outcome of the study was re-bleeding rate within 14 days. Secondary outcome included hospital stay, volume of blood transfusion, surgical intervention and mortality within 1 month.ResultsFrom April 2010 to Feb 2011, 100 patients were enrolled in this study. The re-bleeding rates were 4% (2/50) in the intravenous group and 4% (2/50) in the oral group. There was no difference between the two groups with regards to the hospital stay, volume of blood transfusion, surgery or mortality rate. The mean duration of hospital stay was 1.8 days in the oral lansoprazole group and 3.9 days in the intravenous esomeprazole group (p > 0.01).ConclusionPatients receiving oral proton pump inhibitor have a shorter hospital stay. There is no evidence of a difference in clinical outcomes between oral and intravenous PPI treatment. However, the study was not powered to prove equivalence or non-inferiority. Future studies are still needed.Trial registrationNCT01123031
Highlights
High dose intravenous proton pump inhibitor after endoscopic therapy for peptic ulcer bleeding has been recommended as adjuvant therapy
It is worth evaluating the benefits of oral pump inhibitor (PPI) and intravenous (IV) PPI in patients with peptic ulcer bleeding [14]
From April 2010 to Feb 2011, peptic ulcer patients with high-risk stigmata were considered eligible if they fulfilled the following inclusion criteria: (i) underwent urgent endoscopy within 24 h after presentation, (ii) had peptic ulcers in the stomach or duodenum, (iii) had high-risk stigmata including active bleeding (Forrest IA, IB), or non-bleeding visible vessels (NBVV, Forrest IIA) and (iv) successful hemostasis was achieved with endoscopic heat probe thermocoagulation or hemoclip placement
Summary
High dose intravenous proton pump inhibitor after endoscopic therapy for peptic ulcer bleeding has been recommended as adjuvant therapy. This study aims to compare the clinical efficacy of oral and intravenous proton pump inhibitor after endoscopic therapy. Proton pump inhibitor (PPI) can reduce re-bleeding and surgery [3,4]. Laine et al [15] and Javid et al [16] proved that oral PPI can achieve a similar intragastric pH with that receiving IV PPI Following up on these evidences, we have observed a similar preventing capability of oral PPI clinically [17]. Oral PPI may be able to replace IV PPI after successful endoscopic therapy
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