Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful endoscopic therapy

BMC Gastroenterol. 2012 Jun 8;12:66. doi: 10.1186/1471-230X-12-66.

Abstract

Background: High dose intravenous proton pump inhibitor after endoscopic therapy for peptic ulcer bleeding has been recommended as adjuvant therapy. Whether oral proton pump inhibitor can replace intravenous proton pump inhibitor in this setting is unknown. This study aims to compare the clinical efficacy of oral and intravenous proton pump inhibitor after endoscopic therapy.

Methods: Patients with high-risk bleeding peptic ulcers after successful endoscopic therapy were randomly assigned as oral lansoprazole or intravenous esomeprazole group. Primary outcome of the study was re-bleeding rate within 14 days. Secondary outcome included hospital stay, volume of blood transfusion, surgical intervention and mortality within 1 month.

Results: From April 2010 to Feb 2011, 100 patients were enrolled in this study. The re-bleeding rates were 4% (2/50) in the intravenous group and 4% (2/50) in the oral group. There was no difference between the two groups with regards to the hospital stay, volume of blood transfusion, surgery or mortality rate. The mean duration of hospital stay was 1.8 days in the oral lansoprazole group and 3.9 days in the intravenous esomeprazole group (p > 0.01).

Conclusion: Patients receiving oral proton pump inhibitor have a shorter hospital stay. There is no evidence of a difference in clinical outcomes between oral and intravenous PPI treatment. However, the study was not powered to prove equivalence or non-inferiority. Future studies are still needed.

Trial registration: NCT01123031.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles / administration & dosage*
  • Administration, Intravenous
  • Administration, Oral
  • Aged
  • Anti-Ulcer Agents / administration & dosage*
  • Blood Transfusion
  • Endoscopy
  • Esomeprazole / administration & dosage*
  • Female
  • Humans
  • Lansoprazole
  • Length of Stay
  • Male
  • Middle Aged
  • Peptic Ulcer / drug therapy
  • Peptic Ulcer / surgery
  • Peptic Ulcer Hemorrhage / prevention & control*
  • Peptic Ulcer Hemorrhage / surgery
  • Proton Pump Inhibitors / administration & dosage*
  • Secondary Prevention
  • Treatment Outcome

Substances

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Anti-Ulcer Agents
  • Proton Pump Inhibitors
  • Lansoprazole
  • Esomeprazole

Associated data

  • ClinicalTrials.gov/NCT01123031