High-Dose vs Non–High-Dose Proton Pump Inhibitors After Endoscopic Treatment in Patients With Bleeding Peptic Ulcer

Wang, Chih‐Hung; Huei‐Ming, Matthew; Chou, Hao-Chang; Yen, Zui-Shen; Yang, Chih‐Wei; Fang, Cheng-Chung; Chen, Shyr‐Chyr

doi:10.1001/archinternmed.2010.100

Cited by 79 publications

(47 citation statements)

References 45 publications

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“…Our results exhibit strong consistency with those suggested by Zhang et al who concluded that PPI is more effective than H2RA for UGH patients [58]. Another study indicates that high-dose PPI is as effective as low-dose PPI with respect to the risk of rebleeding, need for surgery and mortality [59,60]. As suggested by previous studies, the effectiveness and tolerability of PPI is not significantly affected by its administration routes.…”

Section: Discussionsupporting

confidence: 91%

Systematic Review and Net-Work Meta-Analysis of Upper Gastrointestinal Hemorrhage Interventions

Jiang

Chen²,

Gao³

2016

Cell Physiol Biochem

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Background/Aims: Upper gastrointestinal hemorrhage (UGH) is a serious medical condition which affects a large number of individuals. Endoscopic therapy accompanied by medication is a standard approach that is used to improve the prognosis of UGH patients and a few medications have been developed including proton pump inhibitors (PPIs), histamine H₂ receptor antagonist (H2RA), somatostatin analogues and tranexamic acid. This study is set to compare the efficacy and safety of various medical interventions that are used to manage upper gastrointestinal bleeding. Methods: We searched PubMed, Cochrane Library, and Embase for relevant articles. Eligible studies were determined by using both the inclusion and exclusion criteria. Both traditional pair-wise meta-analysis and net-work analysis were carried out to evaluate the corresponding interventions. Results and Conclusion: PPI is an effective medication for UGH patients and intravenous PPI exhibits equivalent effectiveness and safety in comparison to oral PPI. H2RA is not recommended for UGH patients as patients treated with H2RA are associated with an increased risk of adverse events including rebleeding, need for surgery and all-cause mortality. Moreover, patients treated with H2RA exhibit an increased length of average hospital stay and blood transfusion amount compared to those treated with PPI. Tranexamic acid is also considered as another promising medication for UGH.

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Section: Discussionsupporting

confidence: 91%

Systematic Review and Net-Work Meta-Analysis of Upper Gastrointestinal Hemorrhage Interventions

Jiang

Chen²,

Gao³

2016

Cell Physiol Biochem

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“…In light of the data from a Cochrane analysis [41] and a meta-analysis [42,] a high-dose PPI therapy cannot generally be recommended for each case of peptic ulcer bleeding, but it seems to be justified if a high-risk bleeding stigmata is present. If the HP test was not already performed during the acute endoscopy, the report should recommended it be done ([3] chapter 4.4).…”

Section: Quality Indicators/parameters For Specific Proceduresmentioning

confidence: 99%

Quality Assurance in Endoscopy: Which Parameters?

Denzer

2016

Visc Med

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Background: The verbalisation of quality standards and parameters by medical societies are relevant for qualitative improvement but may also be an instrument to demand more resources for health care or be a unique characteristic. Within the health care system 3 different quality levels can be defined: structure, process and result quality. Methods: The current S2k guideline of the German Society for Gastroenterology (quality requirements for gastrointestinal endoscopy) AWMF registry no. 021-022 provides recommendations based on the available evidence for the structure quality (requirements for equipment, human resources) as well as for the process quality (patient preparation, conduct, documentation) and result quality (follow-up of specific endoscopic procedures). Results: Based on these recommendations, measurable quality indicators/parameters for the endoscopy have been selected and formulated. General quality parameters for endoscopic examinations are given as well as quality parameters for specific procedures for the preparation, conduct, and follow-up of specific endoscopic interventions. Conclusion: Only the regular review of processes and courses by means of defined measurement parameters builds up the basis for corrections based on facts. In addition, the implementation of recommended standards may be an instrument in demanding more resources from the health care system and, therefore, should be embedded as routine.

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“…41 Examples of 'less is more' include low-dose intravenous bolus injections of proton pump inhibitors versus continuous high-dose infusions in bleeding peptic ulcers, 42 short (5 days) versus standard ( 10 days) duration oral steroids in acute exacerbations of chronic obstructive pulmonary disease, 43 short (2-4 days) versus standard (7-14 days) duration antibiotics in paediatric urinary tract infections 44 and clinically indicated versus routine (every 72 h) replacement of intravenous cannulas. 45 Where different interventions are available for the same disease, the less cost-effective options are often chosen under the influence of commercial interests or regulatory requirements.…”

Section: Select Care Options According To Comparative Cost-effectivenessmentioning

confidence: 99%

Ten clinician-driven strategies for maximising value of Australian health care

Scott¹

2014

Aust. Health Review

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Objective. To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.Methods. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.Results. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low-or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.Conclusions. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low-to highvalue care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

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High-Dose vs Non–High-Dose Proton Pump Inhibitors After Endoscopic Treatment in Patients With Bleeding Peptic Ulcer

Abstract: Compared with non-high-dose PPIs, high-dose PPIs do not further reduce the rates of rebleeding, surgical intervention, or mortality after endoscopic treatment in patients with bleeding peptic ulcer.

Cited by 79 publications

References 45 publications

Systematic Review and Net-Work Meta-Analysis of Upper Gastrointestinal Hemorrhage Interventions

Systematic Review and Net-Work Meta-Analysis of Upper Gastrointestinal Hemorrhage Interventions

Quality Assurance in Endoscopy: Which Parameters?

Ten clinician-driven strategies for maximising value of Australian health care

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