Intermittent versus Continuous Pantoprazole Infusion in Peptic Ulcer Bleeding: A Prospective Randomized Study

Abstract

Background and Aim: Rebleeding has remained the most important determinant of poor prognosis in peptic ulcer bleeding. Gastric acid plays an important role in the pathogenesis of rebleeding. We aimed to compare the efficiency of intermittent and continuous pantoprazole infusion treatment on peptic ulcer rebleeding after endoscopic therapy. Materials and Method: In this prospective study, patients with active peptic ulcer bleeding or non-bleeding visible vessel were treated initially with endoscopic therapy. They were randomized to receive intermittent or continuous intravenous pantoprazole treatment. Rebleeding rate, duration of hospital stay, need for total blood transfusion and need for urgent surgery were compared among both groups. Results: Rebleeding rate (6.1 vs. 8.3%), duration of hospital stay (4.17 vs. 4.41), need for total blood transfusion (2.18 vs. 2.59) and need for urgent surgery (4.1 vs. 4.2%) were similar in intermittent and continuous pantoprazole infusion therapy groups, respectively. There was no bleeding-related death in either group. Conclusion: In patients with peptic ulcer bleeding, intermittent and continuous pantoprazole infusion after successful endoscopic therapy have comparable outcomes in reducing rebleeding. Both have similar effects on hospital stay, need for blood transfusion and urgent surgery. Intermittent administration has application and cost advantages over continuous infusion.

High-dose vs. Low-dose Proton Pump Inhibitors post-endoscopic hemostasis in patients with bleeding peptic ulcer. A meta-analysis and meta-regression analysis

“…Ten of 859 screened RCTs were finally included (2,7,8,(11)(12)(13)(14)(15)(16)(17) with a total of 1.651 participants.…”

“…All RCTs regarding low-versus high-dose PPI administration post-endoscopic hemostasis were identified (2,7,8,(11)(12)(13)(14)(15)(16)(17). In keeping with identification of suitable studies, the electronic databases Medline, Embase, PubMed, and the Cochrane Library were utilized to identify articles from 2000 to 2016 in the English language literature which included the following terms and/or amalgamations in their keyword lists, abstracts, or titles: RCT, double-blind, dexlansoprazole, omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole, high-dose PPI, low-dose PPI, PPI, and bleeding.…”

“…The difference between failed hemostasis and rebleeding was not distinctly defined. Four studies (2,14,15,17) excluded patients from registration if they did not have spontaneous hemostasis or bleeding was not fostered via endoscopic methods. Consequently, hemorrhage after the primary endoscopic intervention could be considered as rebleeding.…”

“…Only Yüksel et al (17) stated that surgery was contemplated in cases of failure of the second endoscopic treatment. Whether radiologic intervention was considered as a surgical intervention was not evidently specified in studies.…”

“…Of the nine studies providing data for mortality, four studies (2,11,12,17) did not declare the timing of assessment. Hsu et al (13) reported mortality within 14 days.…”