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Efficacy of an intravenous proton pump inhibitor after endoscopic therapy with epinephrine injection for peptic ulcer bleeding in patients with uraemia: a case‐control study
Author(s) -
TSENG G.Y.,
FANG C.T.,
LIN H.J.,
YANG H.B.,
TSENG G.C.,
WANG P.C.,
LIAO P.C.,
CHENG Y.T.,
HUANG C.H.
Publication year - 2009
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2009.04049.x
Subject(s) - medicine , omeprazole , epinephrine , peptic , proton pump inhibitor , blood transfusion , anesthesia , surgery , bolus (digestion) , gastroenterology , peptic ulcer
Summary Background Patients with peptic ulcer bleeding and uraemia are prone to re‐bleeding. Aim To compare the efficacy of an intravenous proton pump inhibitor in treating peptic ulcer bleeding in patients with uraemia and those without uraemia. Methods High‐risk peptic ulcer bleeding patients received endoscopic therapy with epinephrine (adrenaline) injection plus intravenous omeprazole (40 mg bolus followed by 40 mg infusion every 12 h) for 3 days. Re‐bleeding, volume of blood transfusion, hospital stay, need for surgery, and mortality were analysed. Results The uraemic group had similar 7‐day re‐bleeding rate (6/42, 14.29% vs. 6/46, 13.04%, P = 0.865) to that of non‐uraemic patients, but more re‐bleeding episodes beyond 7 days (4/42, 9.52% vs. 0/46, 0%, P = 0.032, OR [95% CI] = 1.105 [1.002–1.219]) and all‐cause mortality (4/42 vs. 0/46 P = 0.032, OR [95% CI] = 1.105 [1.002–1.219]). The uraemic group also had more units of blood transfusion after endoscopic therapy (mean ± s.d. 4.33 ± 3.35 units vs. 2.15 ± 1.65 units, P < 0.001), longer hospital stay (mean ± s.d. 8.55 ± 8.12 days vs. 4.11 ± 1.60 days, P < 0.001) and complications during hospitalization (9/42 vs. 0/46, P = 0.001, OR [95% CI] = 1.273 [1.087–1.490]). Conclusion Endoscopic therapy with epinephrine injection plus an intravenous proton pump inhibitor can offer protection against early re‐bleeding in uraemic patients with peptic ulcer bleeding, but has a limited role beyond 7 days.