Introduction Proton pump inhibitors (PPIs), when given following endoscopy for acute upper gastrointestinal bleeding (UGIB), can reduce the need for blood transfusion and surgery; little is known about their benefit when used in the period before endoscopy.
We therefore aimed to investigate the outcomes of UGIB in patients given intravenous PPIs before their endoscopy.
Methods A total of 404 patients with UGIB were included; 202 received intravenous omeprazole for a median of 1 day (IQR 0.25–2) before endoscopy and 202 did not, this treatment being at their physician’s discretion. Omeprazole was given either in bolus doses of 40-mg bid (n = 103; 51%), or as an infusion of 8-mg/hour after a loading dose of 80-mg (n = 99; 49%). After endoscopy, omeprazole was continued intravenously or orally in patients found to have ulcers/erosions in their oesophagus, stomach, or duodenum. Patients’ clinical details were noted including their Charlson comorbidity and Blatchford risk scores. Three major outcomes were measured: need for blood transfusion; hospital stay > 6 days; and death within 30 days. The Mann-Whitney test, Chi-squared test and logistic regression were used as appropriate
Results The two groups were comparable with respect to their gender, smoking, alcohol intake, and use of NSAIDs, aspirin, anti-thrombotic and other drugs. The treated group was older and had higher Blatchford and Charlson scores. However, when these factors were adjusted for, as shown in Table-1, below, no significant differences were noted between patients who received pre-endoscopic PPI and those who did not in terms of need for blood transfusion, length of hospital stay, or 30-day mortality.
Conclusion The administration of intravenous PPI before endoscopy did not affect the outcomes of acute upper gastrointestinal bleeding in this retrospective study. This is relevant to the appropriate management of this common condition.
Disclosure of Interest A. Taha Consultant for: Horizon Pharma USA; Vifor Pharma UK, E. Saffouri: None Declared, C. McCloskey: None Declared, T. Carigen: None Declared, W. Angerson: None Declared
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