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Pre-endoscopic proton pump inhibitor therapy reduces recurrent adverse gastrointestinal outcomes in patients with acute non-variceal upper gastrointestinal bleeding Keyvani L; Murthy S; Leeson S; Targownik LEAliment Pharmacol Ther 2006[Oct]; 24 (8): 1247-55BACKGROUND: Proton pump inhibitors (PPIs) following endoscopic haemostasis reduce rebleeding rates in patients with high-risk acute non-variceal upper gastrointestinal bleeding. Many advocate the use of PPIs prior to endoscopy, although its incremental benefit is unproven. AIM: To determine if providing PPIs before endoscopy reduces adverse gastrointestinal outcomes in acute non-variceal upper gastrointestinal bleeding patients. METHODS: We performed a retrospective review to identify patients presenting to two tertiary care centres with acute non-variceal upper gastrointestinal bleeding between 1999 and 2004. Subjects receiving PPI therapy before endoscopy were compared with those not receiving pre-endoscopic PPI therapy. The primary outcome measure was the development of any adverse bleeding outcome (rebleeding, surgery for control of bleeding, in-hospital mortality, readmission within 30 days for acute non-variceal upper gastrointestinal bleeding). RESULTS: 385 patients were included in our study [132 (12 intravenous/120 po) pre-endoscopic PPI vs. 253 no pre-endoscopic PPI]. Patients receiving pre-endoscopic PPI therapy were significantly less likely to develop adverse outcomes compared with those not given pre-endoscopic PPIs (25% vs. 13%, P = 0.005). Rebleeding, upper gastrointestinal surgery, mortality and length of hospital stay were also significantly lower in patients receiving pre-endoscopic PPI. CONCLUSIONS: The use of PPIs before endoscopy significantly reduces the risk of developing adverse gastrointestinal outcomes in patients with acute non-variceal upper gastrointestinal bleeding. Future studies are required to better characterize this relationship.|*Proton Pump Inhibitors[MESH]|2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage/adverse effects[MESH]|Acute Disease[MESH]|Administration, Oral[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Drug Therapy, Combination[MESH]|Endoscopy, Gastrointestinal/methods[MESH]|Enzyme Inhibitors/administration & dosage/adverse effects[MESH]|Female[MESH]|Gastrointestinal Hemorrhage/*drug therapy[MESH]|Histamine H2 Antagonists/administration & dosage/adverse effects[MESH]|Humans[MESH]|Infusions, Intravenous[MESH]|Injections, Intravenous[MESH]|Male[MESH]|Middle Aged[MESH]|Omeprazole/administration & dosage/adverse effects[MESH]|Pantoprazole[MESH]|Recurrence[MESH]|Retrospective Studies[MESH]|Treatment Outcome[MESH] |
