engleski

Efficacy of different doses of intravenous pantoprazole application with regard to endoscopic aclerotherapy in prevention of rebleeding from gastroduodenal ulcers type Forrest IIa, b

The aim of this multicenter, prospective, randomized and controlled study was to evaluate the efficacy of different doses of i.v. pantoprazole with regard to endoscopic sclerotherapy by polidocanol in preventing rebleeding from gastroduodenal ulcers F IIa, b. Patients with signs of recent ulcer bleeding F IIa, b on endoscopic examination were included. According to the random numbers table, endoscopic sclerotherapy using polidocanol and i.v. pantoprazole after endoscopic examination were performed during 72 h in one group (A1) while another group (A2) was administered pantoprazole only during 72 h. Endoscopic hemostasis with application of the same pantoprazole dose was performed in case of rebleeding within 72 h. Control endoscopic check-up was conducted after 72 h and F III was considered a final successful outcome. Pantoprazole was administered i.v. in the following doses: a) 80 mg bolus, and 8 mg/h during 72 h, b) 40 mg bolus, and then 3 × 40 mg during 72 h, c) 2 × 40 mg during the first 24 h and then 40 mg daily during 48 h. Statistical analysis was performed using chi-square test. A total of 136 pts had signs of ulcer FIIa, b bleeding (70 gastric and 66 duodenal ulcers), i.e. 80 men, mean age 58.8 yrs, and 56 women, mean age 41.2 yrs. More F IIa duodenal ulcers were found in group A1, and FIIb in group A2 (p = 0.002). There was no difference in rebleeding within 72 h between the groups (p = 0.581) (rebleeding was registered in 4 pts in group A1 and 5 pts in group A2), as well as in ulcer appearance after 72 hours (p = 0.355) (F III was established in 119 ulcers, FIIa, b in 8 ulcers in group A1 and FIIa, b in 9 ulcers in A2). Need for transfusions was similar in both groups. All pts completed the study ; per-protocol. Although gastric pH was not determined in this pilot study, clinical and endoscopic results indicate that all i.v. pantoprazole doses prevent rebleeding from FIIa, b gastric and duodenal ulcer regardless of injection sclerotherapy. The results also suggest that rebleeding from ulcers with F IIa, b can be prevented by standard pantoprazole daily 40 mg dose during 72 h without sclerotherapy.

pantoprazole; bleeding gastroduodenal ulcers; sclerotherapy; rebleeding

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