Double oral esomeprazole after a 3-day intravenous esomeprazole infusion reduces recurrent peptic ulcer bleeding in high-risk patients: a randomised controlled study

Cheng, Hsiu Chi; Wu, Chung Tai; Chang, Wei; Wei, Cheng; Chen, Wei‐Ying; Sheu, Bor Shyang

doi:10.1136/gutjnl-2013-306531

Cited by 42 publications

(38 citation statements)

References 46 publications

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“…T h e ne w e ngl a nd jou r na l o f m e dicine A trial compared once-daily with twice-daily proton-pump inhibitor dosing for 11 days (followed in both groups by 2 weeks of treatment with a proton-pump inhibitor once daily) in highrisk patients who had undergone infusion of a proton-pump inhibitor for 3 days. 32 This trial showed a significantly lower rate of ulcer rebleeding with twice-daily therapy than with oncedaily therapy (11% vs. 29%). Patients with low-risk clinical features (a normal heart rate and blood pressure and no major coexisting conditions), low-risk endoscopic findings (clean-base ulcers, erosions, or nonbleeding Mallory-Weiss tears), and outpatient support can be discharged home after endoscopy, and a regular diet can be resumed 33 (Fig.…”

Section: Endoscopymentioning

confidence: 83%

Upper Gastrointestinal Bleeding Due to a Peptic Ulcer

Laine

2016

N Engl J Med

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A 55-year-old woman presents to the emergency department at 11:30 p.m. with hematemesis. She is otherwise healthy and has no risk factors for liver disease. Her only medication is aspirin (at a dose of 81 mg daily), which she started to take 6 months ago after reading that it reduces the risk of heart disease. The blood pressure is 94/60 mm Hg, and the heart rate is 108 beats per minute; the physical examination is otherwise normal. The hemoglobin level is 11.0 g per deciliter, platelet count 220,000 per cubic millimeter, international normalized ratio 1.0, and blood urea nitrogen level 20 mg per deciliter (7 .1 mmol per liter). How should this case be further evaluated and managed?This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist.The article ends with the author's clinical recommendations.The New England Journal of Medicine Downloaded from nejm.org on June 15, 2016. For personal use only. No other uses without permission.

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Section: Endoscopymentioning

confidence: 83%

Upper Gastrointestinal Bleeding Due to a Peptic Ulcer

Laine

2016

N Engl J Med

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“…Those with high risk endoscopic lesions and clinical features should receive high dose PPIs on days one to three as above, followed by twice daily oral PPI on days four to 14. This regimen is based on an RCT of 187 patients that showed significantly less rebleeding with twice daily versus once daily PPIs (relative risk 0.41, 0.18 to 0.93) during this period 96…”

Section: Post-endoscopic Managementmentioning

confidence: 99%

Management of acute upper gastrointestinal bleeding

Stanley

Laine

2019

BMJ

170

149

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Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 70-80 g/L are recommended. After resuscitation is initiated, proton pump inhibitors (PPIs) and the prokinetic agent erythromycin may be administered, with antibiotics and vasoactive drugs recommended in patients who have cirrhosis. Endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices) and for high risk non-variceal bleeding (for example, injection, thermal probes, or clips for lesions with active bleeding or non-bleeding visible vessel). Patients who require endoscopic therapy for ulcer bleeding should receive high dose proton pump inhibitors after endoscopy, whereas those who have variceal bleeding should continue taking antibiotics and vasoactive drugs. Recurrent ulcer bleeding is treated with repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery. Recurrent variceal bleeding is generally treated with transjugular intrahepatic portosystemic shunt. In patients who require antithrombotic agents, outcomes appear to be better when these drugs are reintroduced early.

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“…We estimated the rate of persistent major SRH at second-look endoscopy to be 18 % according to the average rebleeding rate (7.5 %) after the fourth day with current treatment protocols based on our previous trial 18 , and the average rebleeding risk was estimated to be 40 % with all major SRH cases 2 . In a prospective cohort study, assuming the proposed proportion exposed in the control group was 0.1 and that the proposed control-to-case ratio was 4.5 (0.82/0.18), the statistical power for detecting an odds ratio (OR) of three would be 80 % on the basis of 299 patients using a two-sided test at the α value of 0.05.…”

Section: Methodsmentioning

confidence: 99%

“…In a prospective cohort study, assuming the proposed proportion exposed in the control group was 0.1 and that the proposed control-to-case ratio was 4.5 (0.82/0.18), the statistical power for detecting an odds ratio (OR) of three would be 80 % on the basis of 299 patients using a two-sided test at the α value of 0.05. The estimated incidence of rebleeding during the first 72 hours before the schedule was proposed to be 5 % 8 18 , so at least 315 patients had to be included.…”

Section: Methodsmentioning

confidence: 99%

Risk factors determining the need for second-look endoscopy for peptic ulcer bleeding after endoscopic hemostasis and proton pump inhibitor infusion

Cheng

Chen

et al. 2016

Endosc Int Open

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Background and study aims: The need for routine second-look endoscopy in cases of peptic ulcer bleeding remains uncertain. We investigated risk factors related to the need for second-look endoscopy after endoscopic hemostasis and proton pump inhibitor (PPI) infusion. Patients and methods: We prospectively enrolled 316 patients with peptic ulcer bleeding after endoscopic hemostasis. Second-look endoscopy was scheduled after 72-hour PPI infusion (Day-3 subgroup) or one day early (Day-2 subgroup). If early rebleeding developed within 3 days, emergent second-look endoscopy was conducted. Risk factors for early rebleeding (use of E2nd score to predict the need for early second-look endoscopy) and persistent major stigmata in the Day-3 subgroup (use of R2nd score to predict the need for routine second-look endoscopy) were analyzed using univariable and multivariable regression. Results: Excluding 10 of 316 patients with early rebleeding, the rate of persistent major stigmata was lower in the Day-3 subgroup than in the Day-2 subgroup (4.8 % vs. 15.4 %, P = 0.002). Endoscopic epinephrine-injection monotherapy and hypoalbuminemia < 3.0 g/dL were two independent risk factors for early rebleeding (P ≤ 0.05). The Forrest Ia-Ib type and hypoalbuminemia < 3.5 g/dL were two independent risk factors for persistent major stigmata on the day-3 second-look endoscopy (P < 0.05). The E2nd score was highly accurate for prediction of early rebleeding (AUROC 0.86; 95 % CI, 0.73~0.99), and the R2nd score could predict persistent major stigmata at second-look endoscopy (AUROC 0.84; 95 % CI, 0.69~0.99). Conclusions: For patients with peptic ulcer bleeding, E2nd and R2nd scores can indicate the need for early and routine second-look endoscopy, respectively(Trial registration identifier: NCT02197039).

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Double oral esomeprazole after a 3-day intravenous esomeprazole infusion reduces recurrent peptic ulcer bleeding in high-risk patients: a randomised controlled study

Abstract: NCT01591083.

Cited by 42 publications

References 46 publications

Upper Gastrointestinal Bleeding Due to a Peptic Ulcer

Upper Gastrointestinal Bleeding Due to a Peptic Ulcer

Management of acute upper gastrointestinal bleeding

Risk factors determining the need for second-look endoscopy for peptic ulcer bleeding after endoscopic hemostasis and proton pump inhibitor infusion

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