Sat, Dec 21, 2024
[Archive]
Volume 32, Issue 152 (May & June 2024)
J Adv Med Biomed Res 2024, 32(152): 185-190 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Jafari S, Novin M S, salarpour F. A Comparison between the Impacts of Continuous and Intermittent Intravenous Pantoprazole Injection on High Risk Upper Gastrointestinal Bleeding. J Adv Med Biomed Res 2024; 32 (152) :185-190
URL: http://journal.zums.ac.ir/article-1-7433-en.html
URL: http://journal.zums.ac.ir/article-1-7433-en.html
1- 1. Department of Internal Medicine, Vali-e- Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
2- Department of Immunology-Microbiology, Laval University, Quebec, Canada. ,fatemeh.salarpour.1@ulaval.ca
2- Department of Immunology-Microbiology, Laval University, Quebec, Canada. ,
Abstract: (254 Views)
Background & Objective: Although higher age was previously associated with upper gastrointestinal bleeding (UGIB), rebleeding due to low PH has been recently considered as a crucial prognosis factor. In this regard, pantoprazole, a Proton pump inhibitor (PPIs), along with endoscopy was applied in high-risk patients. As it is an undeniably momentous approach to discover the best PPIs injection method, the advantages and disadvantages of continuous and intermittent PPIs’ infusion were compared in high-risk UGIBs patients.
Materials & Methods: Eighty selected patients were randomly divided into two equal groups. In the continuous infusion, there were 6 and 34 patients with adherent clot ulcers and visible vessel ulcers without bleeding; however, 2 and 38 patients with these ulcers were present in the intermittent infusion group in turn. After three days, ulcers, packed cells, and surgery needs were evaluated between the two groups.
Results: After 72 hours of treatment, 29, 3 and 8 patients in the continuous group showed clean base, flat pigmented spot, and visible vessel ulcer with bleeding, respectively. Whereas in the intermittent group, these records were 35, 5 and 0, respectively (p≤0.028). The number of patients in the continuous infusion group with a visible vessel ulcer was significantly higher (p>0.028). A significant difference was also observed between the groups in terms of length of hospitalizations (p≤0.001) with no mortality.
Conclusion: Based on the findings, the intermittent infusion of PPIs is obviously superior over continuous mode. However, further studies with a larger population are recommended to discover the merits and drawbacks of this method in high-risk UGIBs.
Materials & Methods: Eighty selected patients were randomly divided into two equal groups. In the continuous infusion, there were 6 and 34 patients with adherent clot ulcers and visible vessel ulcers without bleeding; however, 2 and 38 patients with these ulcers were present in the intermittent infusion group in turn. After three days, ulcers, packed cells, and surgery needs were evaluated between the two groups.
Results: After 72 hours of treatment, 29, 3 and 8 patients in the continuous group showed clean base, flat pigmented spot, and visible vessel ulcer with bleeding, respectively. Whereas in the intermittent group, these records were 35, 5 and 0, respectively (p≤0.028). The number of patients in the continuous infusion group with a visible vessel ulcer was significantly higher (p>0.028). A significant difference was also observed between the groups in terms of length of hospitalizations (p≤0.001) with no mortality.
Conclusion: Based on the findings, the intermittent infusion of PPIs is obviously superior over continuous mode. However, further studies with a larger population are recommended to discover the merits and drawbacks of this method in high-risk UGIBs.
Keywords: Upper gastrointestinal bleeding, Proton pump inhibitors, Continuous infusion, Intermittent
Type of Study: Original Article |
Subject:
Clinical medicine
Received: 2024/01/27 | Accepted: 2024/08/7 | Published: 2024/06/21
Received: 2024/01/27 | Accepted: 2024/08/7 | Published: 2024/06/21
References
1. Rockall T, Logan R, Devlin H, Northfield T. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316-21. [DOI:10.1136/gut.38.3.316]
2. Laine L, Yang H, Chang SC, Datto C. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol. 2012;107(8):1190-5. [DOI:10.1038/ajg.2012.168]
3. Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endoscop. 2015;81(4):882-8. e1. [DOI:10.1016/j.gie.2014.09.027]
4. Wuerth BA, Rockey DC. Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: a nationwide analysis. Digest Dis Sci. 2018;63(5):1286-93. [DOI:10.1007/s10620-017-4882-6]
5. Patel R, Mann S. Acute upper gastrointestinal bleeding: endoscopic assessment and treatment. Gastrointest Nurs. 2020;18(Sup1):S26-S35. [DOI:10.12968/gasn.2020.18.Sup1.S26]
6. Kobayashi A, Kishino M, Misumi Y, Nakamura S, Nonaka K, Tokushige K. Characteristics, outcomes, and risk factors for upper gastrointestinal bleeding in patients-A comparison with outpatients. Inter Med. 2023:0614-22. [DOI:10.2169/internalmedicine.0614-22]
7. Yüksel İ, Ataseven H, Köklü S, Ertuğrul İ, Başar Ö, Ödemiş B, et al. Intermittent versus continuous pantoprazole infusion in peptic ulcer bleeding: a prospective randomized study. Digest. 2008;78(1):39-43. [DOI:10.1159/000158227]
8. Julapalli VR, Graham DY. Appropriate use of intravenous proton pump inhibitors in the management of bleeding peptic ulcer. Digest Dis Sci. 2005;50(7):1185-93. [DOI:10.1007/s10620-005-2758-7]
9. Lin HJ, Lo WC, Lee FY, Perng CL, Tseng GY. A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy. Arch Int Med. 1998;158(1):54-8. [DOI:10.1001/archinte.158.1.54]
10. Sachs G, Shin JM, Briving C, Wallmark B, Hersey S. The pharmacology of the gastric acid pump: the H+, K+ ATPase. Ann Rev Pharmacol Toxicol. 1995;35(1):277-305. [DOI:10.1146/annurev.pa.35.040195.001425]
11. Thurber KM, Otto AO, Stricker SL. Proton pump inhibitors: Understanding the associated risks and benefits of long-term use. Am J Health Syst Pharm. 2023; 80(8):487-94 [DOI:10.1093/ajhp/zxad009]
12. Worden JC, Hanna KS. Optimizing proton pump inhibitor therapy for treatment of nonvariceal upper gastrointestinal bleeding. Am J Health Syst Pharm. 2017;74(3):109-16. [DOI:10.2146/ajhp151032]
13. Hung Wk, Li VK, Chung Ck, Ying MW, Loo Ck, Liu CK, et al. Randomized trial comparing pantoprazole infusion, bolus and no treatment on gastric pH and recurrent bleeding in peptic ulcers. ANZ J Surg. 2007;77(8):677-81. [DOI:10.1111/j.1445-2197.2007.04185.x]
14. Yamada S, Wongwanakul P. Randomized controlled trial of high dose bolus versus continuous intravenous infusion pantoprazole as an adjunct therapy to therapeutic endoscopy in massive bleeding peptic ulcer. J Med Assoc Thailand. 2012;95(3):349.
15. Long M, Lichtenstein D. In high-risk ulcers, intermittent and continuous PPI therapy do not differ for recurrent bleeding. Ann Int Med. 2015;162(2):JC8-JC. [DOI:10.7326/ACPJC-2015-162-2-008]
16. Chow L, Gertsch P, Poon R, Branicki F. Risk factors for rebleeding and death from peptic ulcer in the very elderly. Br J Surg. 1998;85(1):121-4. [DOI:10.1046/j.1365-2168.1998.00665.x]
17. Akhtar AJ. Gastrointestinal hemorrhage. Acute emergencies and critical care of the geriatric patient: Marcel Dekker, Inc., New York; 2000. p. 357-68. [DOI:10.1201/9780203910047.ch19]
18. Weledji EP. Acute Upper Gastrointestinal Bleeding: a review. Surgery in Practice and Science. 2020:100004. [DOI:10.1016/j.sipas.2020.100004]
19. Leontiadis GI, Sharma VK, Howden CW, editors. Proton pump inhibitor therapy for peptic ulcer bleeding: Cochrane collaboration meta-analysis of randomized controlled trials. Mayo Clinic Proceedings; 2007: Elsevier. [DOI:10.1002/14651858.CD002094.pub3]
20. Serpico M, Riscinti M. Proton pump inhibitors for acute upper gastrointestinal bleeding. Acad Emerg Med. 2020;27(4):336-8. [DOI:10.1111/acem.13899]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Copyright Policy
