S1105 Rates of Pre- And Post-Endoscopy Proton Pump Inhibitor (PPI) Treatment for Non-Variceal Upper Gastrointestinal Bleeding (UGIB) in Clinical Practice: Results From a Pan-European Study

Abstract

Background and aims: Early endoscopy and predetermined care protocols may impact nonvariceal UGIB outcomes. We report preand post-endoscopy PPI use for non-variceal UGIB in clinical practice. Methods: This was an observational, retrospective, pan-European cohort study to assess outcomes with current management strategies for non-variceal UGIB (NCT00797641; ENERGiB). Patients consecutively admitted to hospital (1 Oct-30 Nov 2008) who underwent endoscopy for overt non-variceal UGIB were eligible. Patient management was at the discretion of each study center. Patient data regarding preand postendoscopy PPI use were collected from medical records. Results: Medical records from 2660 enrolled patients were evaluable. In total, 66% of patients received pre-endoscopy treatment with a PPI (most commonly omeprazole); inter-country variability was high (Table). Intravenous (I.V.) bolus was the most frequent route of administration of all PPIs combined, preendoscopy. In total, 93% of patients received post-endoscopy treatment with a PPI (most commonly pantoprazole); inter-country variability was lower than with pre-endoscopy treatment (Table); I.V. infusion was the most frequent route for all PPIs combined, post-endoscopy. Doses of PPI were much higher when infused vs boluses for all PPIs, pre and post endoscopy. In patients undergoing therapeutic endoscopy (n=847), 10% and 27% of patients still received either oral or PPI boluses post-endoscopy at lower doses than recommended (e.g. omeprazole 37±14mg/24h oral; 96±44mg/24h boluses). Conclusion: There is significant inter-country variation in the rates, routes of administration, and types of PPIs used for the treatment of non-variceal UGIB across Europe, particularly pre-endoscopy. Further analyses are warranted to explore the relationship between pre-endoscopy use of PPIs, doses, routes and major outcomes across countries.