Efficacy of an intravenous proton pump inhibitor after endoscopic therapy with epinephrine injection for peptic ulcer bleeding in patients with uraemia: a case‐control study

Tseng, Guan Ying; Fang, C.-T.; Lin, Hwai Jeng; Yang, Hsio Bai; Tseng, Guan-Chin; Wang, P.-C.; Liao, Pao‐Chi; Cheng, Yao-Wen; Huang, Chiu‐Ching

doi:10.1111/j.1365-2036.2009.04049.x

Cited by 14 publications

(13 citation statements)

References 36 publications

(105 reference statements)

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“…Similarly, a retrospective cohort study found that renal failure and liver disease are two independent prognostic factors of an unfavorable clinical course, including persistent or recurrent bleeding, required interventional therapy, and death [81] . Although most recurrent bleeding develops within 72 h [56,57] , uremic patients have a higher delayed recurrent bleeding risk for 7 to 30 d [10,82] .…”

Section: Factors Related With the Poor Control Of IV Ppis: Cyp2c19 Storymentioning

confidence: 98%

“…In addition, the presence of co-morbidities and poor nutrition status such as uremia and hypoalbuminemia are also the significant indicators of a higher recurrent bleeding rate even when applying intravenous omeprazole infusion [6,10,82] . Kamada et al found that only one-third of patients with H. pylori-negative idiopathic duodenal ulcers may have acid hypersecretion [85] .…”

Section: Limits Of IV Ppis To Control Bleedingmentioning

confidence: 99%

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Intravenous proton pump inhibitors for peptic ulcer bleeding: Clinical benefits and limits Hsiu-Chi Cheng, Bor-Shyang Sheu

Cheng

Sheu

2011

WJGE

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Peptic ulcer bleeding is a common disease and recurrent bleeding is an independent risk factor of mortality. Infusion with proton pump inhibitors (PPIs) prevents recurrent bleeding after successful endoscopic therapy. A gastric acidic environment of less than pH 5.4 alters coagulation function and activates pepsin to disaggregate platelet plugs. Gastric acid is secreted by H(+), K(+)-ATPase, naming the proton pump. This update review focuses on the mechanism and the role of PPIs in the clinical management of patients with peptic ulcer bleeding. An intravenous omeprazole bolus followed by high-dose continuous infusion for 72 h after successful endoscopic therapy can prevent the recurrent bleeding. In the Asian, however, the infusion dosage can possibly be diminished whilst preserving favorable control of the intragastric pH and thereby still decreasing rates of recurrent bleeding. Irrespective of the infusion dosage of PPIs, rates of recurrent bleeding remain high in patients with co-morbidities. Because recurrent peptic ulcer bleeding may be prolonged in those with co-morbidities, a low-dose infusion of IV PPIs for up to 7-day may result in better control of recurrent bleeding of peptic ulcers. Due to the inter-patient variability in CYP2C19 genotypes, the infusion form of new generation PPIs, such as esomeprazole, should be promising for the prevention of recurrent bleeding. This article offers a comprehensive review of clinical practice, highlighting the indication, the optimal dosage, the duration, and the potential limitation of PPIs infusion for peptic ulcer bleeding.

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Section: Factors Related With the Poor Control Of IV Ppis: Cyp2c19 Storymentioning

confidence: 98%

Section: Limits Of IV Ppis To Control Bleedingmentioning

confidence: 99%

Intravenous proton pump inhibitors for peptic ulcer bleeding: Clinical benefits and limits Hsiu-Chi Cheng, Bor-Shyang Sheu

Cheng

Sheu

2011

WJGE

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“…In addition, ESRD is associated with lower albumin levels and poor nutrition, thereby possibly leading to slower ulcer healing and, perhaps, a greater risk of rebleeding (33). The impact of gastric acid secretion remains unclear because it has been shown to be increased in some studies, and decreased or normal in others (33,37).…”

Section: Other Biasmentioning

confidence: 99%

“…Patients with ESRD exhibit higher rates of rebleeding (up to 40.6% in study by Cheung et al [32]), as well as increased delayed rebleeding (beyond seven days) (16,33). ESRD has also been associated with increased long-term peptic ulcer rebleeding (34).…”

Section: Other Biasmentioning

confidence: 99%

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Timing of Rebleeding in High-Risk Peptic Ulcer Bleeding after Successful Hemostasis: A Systematic Review

Ouali

Barkun

Martel

et al. 2014

Canadian Journal of Gastroenterology and Hepatology

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BACKGROUND: Peptic ulcer rebleeding (PUR) usually occurs within three days following endoscopic hemostasis. However, recent data have increasingly suggested delayed rebleeding.OBJECTIVE: To better characterize the timing of PUR (Forrest Ia to IIb) following initially successful endoscopic hemostasis.METHODS: An exhaustive literature search (1989 to 2013), with cross-referencing, was performed to identify pertinent randomized controlled trial (RCT) arms. Patients receiving high-dose proton pump inhibitor (PPI) infusion following successful modern-day endoscopic hemostasis were included. A sensitivity analysis included any patients receiving PPI doses >40 mg daily. The main outcome measure was 30-day rebleeding, while weighted mean averages at t = three, seven, 14 and 28 to 30 days are also reported.RESULTS: Of 756 citations, six RCTs were included (561 patients; 58.5% to 89.5% male; 55.3 to 67.5 years of age). Among patients receiving high-dose PPI (five RCTs [393 patients]), 11.5% (95% CI 8.4% to 14.7%) experienced rebleeding, 55.6% (95% CI 41.1% to 70.1%) rebled within three days, 20% (95% CI 8.3% to 31.7%) between four and seven days, 17.8% (95% CI 6.6% to 28.9%) at eight to 14 days, and 6.7% (95% CI 0% to 14%) at 15 to 28 to 30 days. Using the relaxed lower PPI dosing threshold, similar respective rates were 14.4% (95% CI 11.5% to 17.3%) overall, with interval rates of 39.5% (95% CI 28.9% to 50.15%), 34.6% (95% CI 24.2% to 44.9%), 19.7% (95% CI 11% to 28.4%) and 6.2% (95% CI 0.95% to 11.5%). Qualitative review of patient characteristics, limited by small sample size, possible bias and study heterogeneity, suggested increased patient comorbidity and postendoscopic use of lower PPI dosing may predict delayed rebleeding.CONCLUSION: In patients with high-risk PUR undergoing successful endoscopic hemostasis, most rebled within three days, with many experiencing later rebleeding. Additional research is needed to better predict such an outcome.

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The recurrent bleeding risk of a Forrest IIc lesion at the second-look endoscopy can be indicated by high Rockall scores ≥ 6

Yang

Kuo

et al. 2019

Surg Endosc

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Background The Forrest classification is widely applied to guide endoscopic hemostasis for peptic ulcer bleeding. Accordingly, practice guidelines suggest medical treatment only for ulcer with a Forrest IIc lesion because it has low rebleeding risk even without endoscopic therapy, ranging from 0 to 13%. However, the risk ranges widely and it is unclear who is at risk of rebleeding with such a lesion. This study assessed whether the Rockall score, which evaluates patients holistically, could indicate the risk of recurrent bleeding among patients with a Forrest IIc lesion at the second-look endoscopy. Methods Patients who had peptic ulcer bleeding with Ia-IIb lesions received endoscopic hemostasis at the primary endoscopy, and they were enrolled if their Ia-IIb lesions had been fading to IIc at the second-look endoscopy after 48-to 72-h intravenous proton pump inhibitor (PPI) infusion. Primary outcomes were rebleeding during the 4th-14th day and 4 th-28th day after the first bleeding episode. Results The prospective cohort study enrolled 140 patients, who were divided into a Rockall scores ≥ 6 group or a Rockall scores < 6 group. The rebleeding rates in the Rockall scores ≥ 6 group and the Rockall scores < 6 group during the 4th-14th day and the 4th-28th day were 13/70 (18.6%) versus 2/70 (2.9%), p = 0.003 and 17/70 (24.3%) versus 3/70 (4.3%), p = 0.001, respectively, based on an intention-to-treat analysis and 5/62 (8.1%) versus 0/68 (0%), p = 0.023 and 6/59 (10.2%) versus 0/67 (0%), p = 0.009, respectively, based on a per-protocol analysis. The Kaplan-Meier curves showed that the Rockall scores ≥ 6 group had a significantly lower cumulative rebleeding-free proportion than the Rockall scores < 6 group (p = 0.01). Conclusions Combined Rockall scores ≥ 6 on arrival with a Forrest IIc lesion at the second-look endoscopy can identify patients at risk of recurrent peptic ulcer bleeding following initial endoscopic and intravenous PPI treatment. Trial registration Trial registration identifier: NCT01591083

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Efficacy of an intravenous proton pump inhibitor after endoscopic therapy with epinephrine injection for peptic ulcer bleeding in patients with uraemia: a case‐control study

Abstract: SUMMARY BackgroundPatients with peptic ulcer bleeding and uraemia are prone to re-bleeding.

Cited by 14 publications

References 36 publications

Intravenous proton pump inhibitors for peptic ulcer bleeding: Clinical benefits and limits Hsiu-Chi Cheng, Bor-Shyang Sheu

Intravenous proton pump inhibitors for peptic ulcer bleeding: Clinical benefits and limits Hsiu-Chi Cheng, Bor-Shyang Sheu

Timing of Rebleeding in High-Risk Peptic Ulcer Bleeding after Successful Hemostasis: A Systematic Review

The recurrent bleeding risk of a Forrest IIc lesion at the second-look endoscopy can be indicated by high Rockall scores ≥ 6

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