Abstract
Background and AimThe aim of this study was to evaluate the impact of a change in our institute’s protocol from continuous intravenous (IV) proton pump inhibitor (PPI) therapy to bolus IV PPI therapy for the treatment of peptic ulcer-related bleeding on patient outcomes. Current guidelines recommend PPI therapy through high-dose IV bolus followed by continuous infusion for bleeding ulcers. Conflicting data have been reported regarding the practice shift to intermittent IV PPI therapy.MethodsA retrospective record review was conducted of patients treated at West Virginia University between 2017 and 2018 for peptic ulcer related bleeding who underwent endoscopy and had high-risk stigmata. Relevant variables were identified. Outcomes were compared between groups based on PPI strategy. The primary endpoint was any poor outcome defined as rebleeding, need for embolization or surgery, or mortality during hospital stay.ResultsA total of 130 patients were included, with a mean age of 62.18 years. Continuous PPI infusion was used in 39.23%, whereas bolus IV PPI was used 60.76%. Poor outcome was encountered in 11 (21.57%) patients in the continuous and 33 (41.77%) patients in the bolus group (p = 0.028). On multivariable analyses, bolus PPI strategy was independently linked to poor outcome (Wald’s odds ratio: 2.8; 95% CI: 1.21-6.84; p = 0.019) and an increased need for embolization/surgery (OR: 4.12, 95% CI: 1.14-19.99; p = 0.046).ConclusionsIV bolus therapy showed worse outcomes compared with continuous IV PPI therapy for patients with peptic ulcer bleeding with high-risk features. More robust data are needed before a practice shift to bolus PPI may be appropriate.
Highlights
Peptic ulcer disease (PUD) remains one of the most common causes of upper gastrointestinal (GI) bleeding [1]
Bolus pump inhibitor (PPI) strategy was independently linked to poor outcome (Wald’s odds ratio: 2.8; 95% CI: 1.21-6.84; p = 0.019) and an increased need for embolization/surgery (OR: 4.12, 95% CI: 1.14-19.99; p = 0.046)
IV bolus therapy showed worse outcomes compared with continuous IV PPI therapy for patients with peptic ulcer bleeding with high-risk features
Summary
Peptic ulcer disease (PUD) remains one of the most common causes of upper gastrointestinal (GI) bleeding [1]. Current guidelines recommend proton pump inhibitor (PPI) therapy in the form of an intravenous (IV) bolus followed by a continuous infusion after endoscopic treatment in patients with bleeding ulcers with high-risk endoscopic findings (active bleeding, non-bleeding visible vessels, and adherent clots) [3,4]. We conducted a retrospective cohort study to evaluate the impact of a recent shift in institutional protocol from continuous infusion PPI therapy to bolus therapy in peptic ulcer related bleeding. The aim of this study was to evaluate the impact of a change in our institute’s protocol from continuous intravenous (IV) proton pump inhibitor (PPI) therapy to bolus IV PPI therapy for the treatment of peptic ulcer-related bleeding on patient outcomes. Conflicting data have been reported regarding the practice shift to intermittent IV PPI therapy
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