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Oral, intravenous PPIs comparably treat patients with bleeding ulcers after endoscopy
No difference in clinical outcome was observed between patients with bleeding peptic ulcers treated with oral or intravenous proton pump inhibitors in a recent study.
In a single-center prospective trial, researchers randomly assigned 100 patients to receive either oral (n=50) or intravenous (n=50) proton pump inhibitors (PPI) from April 2010 to February 2011. All participants had received successful endoscopic therapy for high-risk bleeding peptic ulcers.
Patients taking oral PPIs received 30 mg lansoprazole four times a day for 3 days and then once daily for 2 months, and patients in the intravenous group received 40 mg continuous infusion of esomeprazole every 6 hours for 3 days and then 30 mg oral esomeprazole once daily for 2 months. Evaluated factors included re-bleeding rates over 14 days, length of hospital stay, volume of necessary blood transfusion and surgical intervention and mortality within 1 month of treatment.
Two patients each in the intravenous and oral groups experienced re-bleeding within 14 days (4% each), all of which occurred on the second day of enrollment. The mean hospital stay was 1.8 days in the oral group, compared with 3.9 days in the intravenous group (P<.01). No incidents of surgical intervention or mortality occurred in either group, and no significant difference was found in the volumes of transfused blood in the two groups (mean 781 mL for the intravenous group; 520 mL for the oral group, P>.1).
“This study suggests a similar clinical outcome between oral and intravenous large-dose PPIs as adjuvant therapy to prevent re-bleeding,” the researchers wrote. “Patients with oral PPIs have a shorter hospital stay. However, the study was not powered to prove equivalence or non-inferiority. A larger trial is required to further clarify the role of oral PPIs in patients with high-risk bleeding ulcers.”