PMID- 34449479
OWN - NLM
STAT- MEDLINE
DCOM- 20210908
LR  - 20230103
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 100
IP  - 34
DP  - 2021 Aug 27
TI  - Clinical outcomes of esophagogastroduodenoscopy in critically ill patients using 
      high-dose proton pump inhibitor for suspected bleeding: A retrospective cohort 
      study.
PG  - e27028
LID - 10.1097/MD.0000000000027028 [doi]
LID - e27028
AB  - Esophagogastroduodenoscopy (EGD) is a useful procedure performed for 
      gastrointestinal (GI) bleeding. No definite clinical guidelines recommend EGD 
      implementation in intensive care unit (ICU) patients with suspected GI bleeding. 
      The objective of this study was to compare the clinical effectiveness of EGD in 
      critically ill patients who are using high-dose proton pump inhibitor (PPI) for 
      suspected GI bleeding.We retrospectively analyzed ICU patients using high-dose 
      PPI for suspected GI bleeding from January 2012 to September 2020. Major cases of 
      GI bleeding, such as those with hematemesis and hematochezia, were excluded, and 
      1:1 propensity score matching was performed. The change in hemoglobin level, 
      requirement of red blood cell transfusion, re-suspected bleeding event, length of 
      ICU stay, and ICU mortality were compared between the EGD and non-EGD groups.Of 
      the 174 subjects included, 52 patients underwent EGD within 24 hours of PPI 
      administration. In the EGD group, 22 (42.3%) patients showed normal findings, 
      while esophagitis and gastritis were most common abnormal finding (n = 11, 
      21.2%), and 14 patients (26.9%) underwent a hemostatic procedure. While comparing 
      the 2 groups, the EGD group required a higher amount of red blood cell 
      transfusion (packs) than the non-EGD group for a week (3.04 +/- 0.44 vs 
      2.07 +/- 0.25, P = .01). There was no significant difference in the change in 
      hemoglobin level after 1 week (P = .15). After propensity score matching, the EGD 
      group showed similar the requirement of red blood cell transfusion and change in 
      hemoglobin level for a week (P = .52, P = .97, respectively). In analyses for all 
      patients and propensity score matched patients, there was no statistically 
      significant difference in term of re-suspected bleeding event rate, duration of 
      ICU stay, and ICU mortality. However, re-suspected bleeding event rate and ICU 
      mortality were lower trend in the EGD group than the non-EGD group.This study 
      showed that EGD had no definite clinical benefit in ICU patients using high-dose 
      PPI for suspected GI bleeding and aggressive EGD is not necessarily recommended. 
      However, it is necessary to consider EGD in patients who are tolerant.
CI  - Copyright (c) 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
FAU - Kwack, Won Gun
AU  - Kwack WG
AUID- ORCID: 0000-0001-9611-4341
AD  - Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal 
      Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Hemoglobins)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - *Critical Illness
MH  - Endoscopy, Digestive System/*statistics & numerical data
MH  - Erythrocyte Transfusion
MH  - Gastrointestinal Hemorrhage/*drug therapy/*surgery
MH  - Hemoglobins
MH  - Hospital Mortality
MH  - Humans
MH  - Intensive Care Units/statistics & numerical data
MH  - Length of Stay
MH  - Propensity Score
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Recurrence
MH  - Retrospective Studies
PMC - PMC8389866
COIS- The author has no conflicts of interest to disclose.
EDAT- 2021/08/28 06:00
MHDA- 2021/09/09 06:00
PMCR- 2021/08/27
CRDT- 2021/08/27 17:22
PHST- 2021/02/21 00:00 [received]
PHST- 2021/08/07 00:00 [accepted]
PHST- 2021/08/27 17:22 [entrez]
PHST- 2021/08/28 06:00 [pubmed]
PHST- 2021/09/09 06:00 [medline]
PHST- 2021/08/27 00:00 [pmc-release]
AID - 00005792-202108270-00027 [pii]
AID - MD-D-21-01479 [pii]
AID - 10.1097/MD.0000000000027028 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2021 Aug 27;100(34):e27028. doi: 
      10.1097/MD.0000000000027028.