Related Experiment Video
Updated: Apr 9, 2026
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Nonvariceal Upper GI Bleeding in Established Users of Proton-Pump Inhibitors: Higher Incidence But Better Outcomes
Ali S Taha1,2, Caroline McCloskey1, Theresa Craigen1
1University Hospital Crosshouse, Kilmarnock, Scotland, United Kingdom.
Introduction:
Nonvariceal upper gastrointestinal bleeding (NVUGIB) still occurs despite taking proton-pump inhibitors (PPIs). We tested the hypothesis that PPI efficacy fades with time.
Methods:
This is a prospective and controlled observational comparison of cases of NVUGIB arising from the adult PPI-users' and nonusers' subpopulations of a well-defined community. Patients presenting with NVUGIB were grouped into PPI-users (index group) and nonusers (control group).
Results:
The incidence of NVUGIB in our overall adult population was 89.7 in 2019 and 115.1 per 100,000 in 2022 ( P = 0.01). Over the 2 years, the incidence of NVUGIB in the non-PPI subpopulation was 59.3 vs 364.4 in the PPI subpopulation ( P < 0.0001). In the index group (n = 213), 21 (9.9%) patients developed duodenal ulcers vs 44 (20.2%) in the control group (n = 211; P = 0.002); 162 (76.1%) were admitted vs 188 (89.1%), P < 0.001; 54 (25.5%) required transfusion vs 74 (35.2%), P = 0.034; and there was a 30-day mortality of 8 (3.8%) vs 18 (8.5%), P = 0.044, respectively in controls. Of 15 cases in the index group with gastric ulcer, 9 (60%) developed in the fourth quartile of duration of PPI use (76-180 months). The duration of PPI use grouped by quartiles was a significant predictor of a finding of gastric ulcer (odds ratio 2.39, 95% CI 1.29-4.46, P = 0.006).
Discussion:
Apart from gastric ulceration, there was no consistent evidence of a decline in PPI efficacy with time. The need for and long-term use of PPI may identify those at a higher risk of NVUGIB.
Registration:
International Standard Randomised Clinical Trial number ISRCTN14750381.
Related Concept Videos
01:30Peptic Ulcer Disease I: Introduction
An acute ulcer, marked by superficial erosion and minimal inflammation, swiftly resolves upon identifying and addressing the underlying cause. In contrast, a chronic ulcer persists, potentially eroding through the muscular wall and forming fibrous tissue.
Peptic ulcers can also be...
01:13Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
01:27Peptic Ulcer
01:24Esophageal Varices-I: Introduction
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...