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Paper Information

Journal:   MIDDLE EAST JOURNAL OF DIGESTIVE DISEASES (MEJDD)   JULY 2014 , Volume 6 , Number 3; Page(s) 137 To 148.
 
Paper: 

HIGH DOSE VERSUS LOW DOSE INTRAVENOUS PANTOPRAZOLE IN BLEEDING PEPTIC ULCER: A RANDOMIZED CLINICAL TRIAL

 
 
Author(s):  MASJEDIZADEH ABDOL RAHIM*, HAJIANI ESKANDAR, ALAVINEJAD PEZHMAN, HASHEMI SEYED JALAL, SHAYESTEH ALI AKBAR, JAMSHIDIAN NOORDIN
 
* DIVISION OF GASTROENTEROLOGY AND HEPATOLOGY, DEPARTMENT OF INTERNAL MEDICINE
 
Abstract: 

BACKGROUND: the appropriate dose of proton pump inhibitors for treatment of patients with upper (GI) bleeding remains controversial. This study compares high-dose versus low-dose intravenous proton pump inhibito (PPI) infusion for prevention of GI bleeding complications.
METHODS: A total of 166 patients with bleeding peptic ulcers underwent therapeutic endoscopy using concomitant therapy by argon plasma coagulation (APC) and diluted epinephrine injection. Patients were randomly divided into two groups: high-dose pantoprazole (80 mg bolus, 8 mg per hour) and low-dose pantoprazole (40 mg bolus, 4 mg per hour) infused for three days. Initial outcomes were rebleeding, need for surgery, hemoglobin drop more than two units, and hospitalization for more than five days. Secondary outcome included mortality rate.
RESULTS: Overall, 166 patients (83 patients per group) enrolled in the study. The average age of patients in the high-dose group was 59.5
±15.6 years and 52.3±13.3 years in the low-dose group (p=0.58). Males comprised 69.7% of patients. In the high-dose group, the mean number of units of transfused blood was 3.3±1.71 and in the low-dose group, it was 2.82±1.73 (p=0.50). There were 36 (43.37%) patients in the high-dose group and 40 (48.19%) in the low-dose group who were hospitalized for more than 5 days (p=0.53). Rebleeding was observed in 27 (32.53%) patients in the high-dose group and in 21 (25.30%) in the low-dose group (p=0.30). There were no significant differences observed in drop in hemoglobin of more than two units (p=0.15), mortality (p=0.99) and surgery (p=0.75) between the two groups.
CONCLUSION: For controlling peptic ulcer bleeding, there is no difference between high dose and low dose pantoprazole infusion.

 
Keyword(s): PANTOPRAZOLE, BLEEDING PEPTIC ULCER, ENDOSCOPY
 
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