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Pre-endoscopic intravenous proton pump inhibitors therapy for upper gastrointestinal bleeding: A prospective,
Riccardo Marmo1, Marco Soncini2, Cristina Bucci1
1Gastroenterology Unit, L. Curto Hospital, Polla, Salerno, Italy.
Insights
High-dose proton pump inhibitor (PPI) infusions did not reduce high-risk stigmata in upper gastrointestinal bleeding patients. Early endoscopy timing, not PPI therapy, independently influenced bleeding risk in this patient group.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Endoscopy
Background:
- High-dose proton pump inhibitor (PPI) infusions are commonly used for non-variceal upper gastrointestinal bleeding (UGIB).
- The efficacy of pre-endoscopic PPI therapy in reducing high-risk stigmata (HRS) in peptic ulcers is debated.
- This study evaluates PPI use and its impact on HRS prevalence in UGIB patients.
Purpose of the Study:
- To assess the prevalence of HRS in peptic ulcers and non-ulcer lesions.
- To compare HRS rates and endoscopic therapy needs between patients receiving and not receiving pre-endoscopic PPI therapy.
- To identify independent factors influencing HRS prevalence in UGIB.
Main Methods:
- Analysis of consecutive UGIB patient data from 50 Italian centers.
- Comparison of HRS prevalence on peptic ulcers and active bleeding on non-ulcer lesions between PPI-treated and non-treated groups.
- Multivariate analysis to determine independent factors for HRS.
Main Results:
- 51.8% of PPI-treated patients and 53.4% of non-treated patients had HRS on ulcers (P=0.58).
- Non-ulcer bleeding lesions were more frequent in PPI-treated patients (18.7% vs 10.6%, P=0.023).
- PPI therapy was not an independent factor for HRS; earlier endoscopy timing was inversely correlated with HRS.
Conclusions:
- Pre-endoscopic PPI therapy did not significantly decrease HRS prevalence in bleeding ulcers or non-ulcer lesions.
- The need for endoscopic treatment was not reduced by pre-endoscopic PPI therapy.
- Endoscopy timing, not PPI use, is a key factor in managing UGIB with high-risk stigmata.
Background/Aim:
The indiscriminate use of high-dose, proton pump inhibitor (PPI) infusion in non-variceal upper gastrointestinal bleeding (UGIB) patients to reduce the rate of peptic ulcers with high-risk stigmata (HRS) has been questioned. We evaluated the prevalence of HRS on peptic ulcer and non-ulcer lesions in patients receiving or not receiving pre-endoscopic PPI therapy.
Methods:
Data of consecutive UGIB patients observed in 50 Italian centres were analysed. The prevalence of both HRS on peptic ulcers and active bleeding on non-ulcer lesions between patients treated or not treated with PPI were compared. Multivariate analysis was performed.
Results:
A total of 1,792 (69.8%) out of 2,566 patients received PPI therapy. Prevalence of HRS on ulcers was 51.8% and 53.4% (P = 0.58) in treated and not treated patients, respectively, and the rate of endoscopic therapy did not differ between groups. Prevalence of non-ulcer bleeding lesions was higher in patients treated than in those not treated with PPI (18.7% vs 10.6%; P = 0.023). At multivariate analysis, PPI therapy (OR: 1.16, 95% CI = 0.82-1.64; P = 0.4) was not an independent factor affecting HRS prevalence, which was inversely correlated with timing to endoscopy (OR: 0.85, 95% CI = 0.76-0.95; P = 0.005).
Conclusions:
Our data failed to detect a significant role of pre-endoscopic PPI therapy in decreasing prevalence of HRS and need for endoscopic treatment in bleeding patients with either peptic ulcer or non-ulcer lesions.
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