PMID- 32617233
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210821
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 12
IP  - 5
DP  - 2020 May 30
TI  - Skipping the Drip: Intravenous Proton Pump Inhibitor Bolus Therapy Leads to Poor 
      Outcomes in High-Risk Bleeding.
PG  - e8362
LID - 10.7759/cureus.8362 [doi]
LID - e8362
AB  - Background and Aim The aim of this study was to evaluate the impact of a change 
      in our institute's protocol from continuous intravenous (IV) proton pump 
      inhibitor (PPI) therapy to bolus IV PPI therapy for the treatment of peptic 
      ulcer-related bleeding on patient outcomes. Current guidelines recommend PPI 
      therapy through high-dose IV bolus followed by continuous infusion for bleeding 
      ulcers. Conflicting data have been reported regarding the practice shift to 
      intermittent IV PPI therapy. Methods A retrospective record review was conducted 
      of patients treated at West Virginia University between 2017 and 2018 for peptic 
      ulcer related bleeding who underwent endoscopy and had high-risk stigmata. 
      Relevant variables were identified. Outcomes were compared between groups based 
      on PPI strategy. The primary endpoint was any poor outcome defined as rebleeding, 
      need for embolization or surgery, or mortality during hospital stay. Results A 
      total of 130 patients were included, with a mean age of 62.18 years. Continuous 
      PPI infusion was used in 39.23%, whereas bolus IV PPI was used 60.76%. Poor 
      outcome was encountered in 11 (21.57%) patients in the continuous and 33 (41.77%) 
      patients in the bolus group (p = 0.028). On multivariable analyses, bolus PPI 
      strategy was independently linked to poor outcome (Wald's odds ratio: 2.8; 95% 
      CI: 1.21-6.84; p = 0.019) and an increased need for embolization/surgery (OR: 
      4.12, 95% CI: 1.14-19.99; p = 0.046). Conclusions IV bolus therapy showed worse 
      outcomes compared with continuous IV PPI therapy for patients with peptic ulcer 
      bleeding with high-risk features. More robust data are needed before a practice 
      shift to bolus PPI may be appropriate.
CI  - Copyright (c) 2020, Khan et al.
FAU - Khan, Raja Samir
AU  - Khan RS
AD  - Internal Medicine, West Virginia University School of Medicine, Morgantown, USA.
FAU - Hadi, Yousaf B
AU  - Hadi YB
AD  - Internal Medicine, West Virginia University School of Medicine, Morgantown, USA.
AD  - Internal Medicine, J.W. Ruby Memorial Hospital, Morgantown, USA.
FAU - Chima, Noor
AU  - Chima N
AD  - Medicine, West Virginia University School of Medicine, Morgantown, USA.
FAU - Kupec, Justin
AU  - Kupec J
AD  - Gastroenterology and Hepatology, West Virginia University School of Medicine, 
      Morgantown, USA.
LA  - eng
GR  - U54 GM104942/GM/NIGMS NIH HHS/United States
PT  - Journal Article
DEP - 20200530
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7325381
OTO - NOTNLM
OT  - peptic ulcer
OT  - proton pump inhibitor
OT  - upper gastrointestinal bleeding
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/07/04 06:00
MHDA- 2020/07/04 06:01
PMCR- 2020/05/30
CRDT- 2020/07/04 06:00
PHST- 2020/07/04 06:00 [entrez]
PHST- 2020/07/04 06:00 [pubmed]
PHST- 2020/07/04 06:01 [medline]
PHST- 2020/05/30 00:00 [pmc-release]
AID - 10.7759/cureus.8362 [doi]
PST - epublish
SO  - Cureus. 2020 May 30;12(5):e8362. doi: 10.7759/cureus.8362.