High-dose versus low-dose intravenous proton pump inhibitor treatment for bleeding peptic ulcers

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Trials

Background:

• Peptic ulcer bleeding (PUB) is a critical condition with high mortality and costs.
• Proton pump inhibitors (PPIs) are standard treatment, but optimal dosing and administration remain debated.
• Guidelines recommend PPIs, yet optimal strategies for acute PUB require further clarification.

Discussion:

• This study evaluated high-dose continuous intravenous infusion versus low-dose twice-daily intravenous bolus PPIs in 875 acute PUB patients.
• The high-dose infusion regimen demonstrated significant reductions in rebleeding rates and blood transfusion needs.
• Hospital length of stay was also reduced with the high-dose regimen, suggesting improved resource utilization.

Key Insights:

• High-dose continuous intravenous PPI infusion is more effective than low-dose bolus for reducing rebleeding in acute peptic ulcer bleeding.
• No significant differences were observed in mortality or the need for endoscopic or surgical intervention between the two regimens.
• The findings support optimizing PPI therapy to improve outcomes and reduce healthcare burden in PUB.

Outlook:

• Further research may explore cost-effectiveness of high-dose PPI infusion strategies.
• Investigating patient-specific factors influencing PPI response in PUB is warranted.
• Comparative studies across diverse healthcare settings could validate these findings.