High- versus low-dose proton pump inhibitors after endoscopic hemostasis in patients with peptic ulcer bleeding: A multicentre, randomized study

Angelo Andriulli, Silvano Loperfido, Rosaria Focareta, Pietro Leo, Fabio Fornari, Antonietta Garripoli, Paolo Tonti, Sergio Peyre, Antonio Spadaccini, Riccardo Marmo, Antonio Merla, Alessandro Caroli, Gian Battista Forte, Angelo Belmonte, Giovanni Aragona, Gianni Imperiali, Fabrizio Forte, Fabio Monica, Nazario Caruso, Francesco Perri

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Abstract

BACKGROUND: The most effective schedule of proton pump inhibitor (PPI) administration following endoscopic hemostasis of bleeding ulcers remains uncertain. METHODS: Patients with actively bleeding ulcers and those with nonbleeding visible vessel or adherent clot were treated with epinephrine injection and/or thermal coagulation, and randomized to receive intravenous PPIs according to an intensive regimen (80 mg bolus followed by 8 mg/h as continuous infusion for 72 h) or a standard regimen (40 mg bolus daily followed by saline infusion for 72 h). After the infusion, all patients were given 20 mg PPI twice daily orally. The primary end point was the in-hospital rebleeding rate, as ascertained at the repeat endoscopy. RESULTS: Bleeding recurred in 28 of 238 patients (11.8%) receiving the intensive regimen, and in 19 of 236 (8.1%) patients receiving the standard regimen (P = 0.18). Most rebleeding episodes occurred during the initial 72-h infusion: 18 (7.6%) and 19 events (8.1%) in the intensive and standard groups, respectively (P = 0.32). Mean units of blood transfused were 1.7 ± 2.1 in the intensive and 1.5 ± 2.1 in the standard regimen group (P = 0.34). The duration of hospital stay was

Original languageEnglish
Pages (from-to)3011-3018
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume103
Issue number12
DOIs
Publication statusPublished - Dec 2008

ASJC Scopus subject areas

  • Gastroenterology
  • Medicine(all)

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    Andriulli, A., Loperfido, S., Focareta, R., Leo, P., Fornari, F., Garripoli, A., Tonti, P., Peyre, S., Spadaccini, A., Marmo, R., Merla, A., Caroli, A., Forte, G. B., Belmonte, A., Aragona, G., Imperiali, G., Forte, F., Monica, F., Caruso, N., & Perri, F. (2008). High- versus low-dose proton pump inhibitors after endoscopic hemostasis in patients with peptic ulcer bleeding: A multicentre, randomized study. American Journal of Gastroenterology, 103(12), 3011-3018. https://doi.org/10.1111/j.1572-0241.2008.02149.x