engleski

High dose proton pump inhibitors in the treatment of intensive setting patients with peptic ulcer bleeding: fact or fictions

INTRODUCTION/OBJECTIVES: Peptic ulcer bleeding is a common problem for admition of patients to intensive care unit. AIMS & METHODS: The aim of this study was to compare efficacy of high versus low doses of proton inhibitors pump (PPI) in the treatment of patients with peptic ulcer bleeding admitted to an intensive care unit. Patients and Methods: 72 patients (28F/44M), mean age 61 yrs, presenting with ulcer bleeding, after successful endoscopic hemostasis, were studied. The patients were randomized into two groups. Group A consisted of 36 patients who were treated with an initial dose of 80 mg pantoprazole followed by continuous iv infusion of 8 mg/h during 48 h. Group B consisted of 36 patients who are treated with an initial dose of 80 mg pantoprazole followed with standard dose of 2×40 mg daily during 48 h. After 48 h the patients in both groups were treated with 2×40 mg twice daily, 5 days. Both groups were comparable with age, gender and co morbidity. The effect variable were: duration of stay in ICU, number of blood transfusions, mean hemoglobin values after treatment, stabilization of the lesion by repeat endoscopy, number of rebleeding, surgical intervention and mortality in first 6 days. Patients were evaluated after 48 hours and after 6 days of treatment. RESULTS: In group A, endoscopic stabilization rate was significantly higher than in group B (31 pts of 36 pts-86%, versus 22 pts of 36 pts 61% in group B. P = 0.012 The overall bleeding recurrence rate was in group A significantly lower in comparison with group B-5 pts of 36 pts 13%, vrs 14 pts of 36 pts- 38%.P<0.001. The duration of stay in ICU in group A was significantly lower 4.8 days vs. 7.9 days in group B. P<0.001. The number of blood transfusion units was significantly lower in group A than in group B (1.8 units vs. 3.1). P<0.001. The mean hemoglobin values within the first 48 h after treatment were also lower in group A than in group B. No significant difference was found for surgical intervention between studied groups (in group A 2 pts, in group B 4 pts P = 0.08 Also, no significant difference was observed in mortality rate between two groups. No major side effects were identified in either study group. CONCLUSION: Our data suggested that in patients with bleeding ulcer, after successful endoscopic hemostasis, administration of pantoprazole continuous infusion was superior to prevent rebleeding and stabilization of the lesion by repeat endoscopy than standard dose of pantoprasole.

peptic ulcer; bleeding; therapy; PPI

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