DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20184404

A study to compare the efficacy of intermittent versus continuous regimen of pantaprazole in the management of upper gastrointestinal bleed (non variceal)

Uday Mahajan, Dhiraj Kapoor, B. S. Rana, Pankaj Kumar, Dinesh Kumar, Sayan Malakar, Bhagwan Dass, Abhimanyu Patial, Guriqbal Singh

Abstract


Background: UGI bleeding is defined as bleeding that occurs in the digestive tract proximal to the ligament of treitz. Intermittent dosage regimen IV bolus and high dose IV continuous infusion forms helps in achieving and maintaining this pH goal of more than 6 which forms optimal environment for peptic ulcer healing and clot stabilization to occur. Theoretically, high-dose IV continuous infusion should provide the most potent acid suppression. Aims and objective was to compare the efficacy of intermittent dose of pantoprazole given for 3 days i.e. 40mg intravenous twice a day versus continuous infusion dose of pantaprazole i.e. 80mg intravenous bolus followed by 8mg/hour for first 72hours in the treatment of UGI bleed.

Methods: Patients of UGI bleed were randomly assigned to receive either continuous or intermittent regimen of pantaprazole as a part of management.

Results: Among 118 patients of peptic ulcer disease, 7 patients had rebleed and 111 patients had no rebleed.3 patients among 59 patients who received continuous regimen and 4 patients among 59 patients who received intermittent regimen had rebleed with a total of 7 patients among 118 patients. Among 118 patients only 2 patients of the total had need for surgery for stabilization. Among 59 patients who received continuous regimen 2 patients needed surgery while none of the 59 patients who received intermittent regimen needed for surgery. Of the 118 patients 10 patients had mortality at the end of 30 day period. In both the regimes 5 patients died.

Conclusions: The difference between Rockall score of the intermittent and continuous regimen group was statistically insignificant. The incidence of rebleed was 5.1 % for continuous and 6.7% for intermittent regimen which was statiscally insignificant. The incidence of mortality was similar 8.5%in both regimen.


Keywords


Continous, Intermittent, Pantroprazole, Upper GI bleed

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References


Scottish Intercollegiate Guidelines Network (SIGN). Management of acute upper and lower gastrointestinal bleeding, 2008. Available at: http://sign.ac.uk/assets/sign105.pdf.

Yavorski RT, Wong RK, Maydonovitch C, Battin LS, Furnia A, Amundson DE. Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol. 1995;90:568-73.

Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995;90:206-10.

Rockey DC. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ (eds). Gastrointestinal and Liver Disease, 8th ed. Philedelphia:Elsevier;2006:255-299.

Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west Scotland: case ascertainment study. BMJ. 1997;315:510-4.

Barkun AN, Cockeram AW, Ploure V, Fedorak RN. Review article: acid suppression in non-variceal acute upper gastrointestinal bleeding. Aliment Pharmacol Ther. 1999;13:1565-84.

Richardson P, Hawkey CJ, Stack WA. Proton pump inhibitors. Pharmacology and rationale for use in gastrointestinal disorders. Drugs. 1998;56:307-35.

Green FW Jr, Kaplan MM, Curtis LE, Levine PH. Effect of acid and pepsin on blood coagulation and platelet aggregation. A possible contributor prolonged gastroduodenal mucosal hemorrhage. Gastroenterology. 1978;74(1):38-43.

Berstad A. Does profound acid inhibition improve haemostasis in peptic ulcer bleeding? Scand J Gastroenterol. 1997;32(4):396-8.

Patchett SE, Enright H, Afdhal N, O’Connell W, O’Donoghue DP. Clot lysis by gastric juice: an in vitro study. Gut. 1989;30(12):1704-7.

Richardson P, Hawkey CJ, Stack WA. Proton pump inhibitors. Pharmacology and rationale for use in gastrointestinal disorders. Drugs 1998;56:307-35.

Lambrecht NW, Yakubov I, Scott D, Sachs G. Identification of the K efflux channel coupled to the gastric H–K-ATPase during acid secretion. Physiol Genomics. 2005;21:81-91

Freston JW, Pilmer BL, Chiu YL, Wang Q, Stolle JC, Griffin JS, et al. Evaluation of the pharmacokinetics and pharmacodynamics of intravenous lansoprazole. Alimentary pharmacology & therapeutics. 2004 May;19(10):1111-22.

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 Intern Med. 1998;158(1):54-8.

Laine L, McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol. 2009;7(1):33-47.

Hartmann M, Ehrlich A, Fuder H, Luhmann R, Emeklibas S, Timmer W, et al. Equipotent inhibition of gastric acid secretion by equal doses of oral or intravenous pantoprazole. Aliment Pharmacol Ther. 1998;12:1027-32.

Welage LS. Pharmacologic features of proton pump inhibitors and their potential relevance to clinical practice. Gastroenterol Clin North Am. 2003;32:S25-35.

Koroushi M. The management of UGI hemmorrahage. Brit J Surg. 1986 APR;77(4):289-302.

Lakhani K, Mundhara S, Sinha R, Gamit Y, Sharma R. Clinical Profile of Acute Upper Gastro Intestinal Bleeding. Available at: http://www.japi.org/july-2008/gastro-enterology-hepatology.

Al-Naamani K, Alzadjali N, Barkun AN, Fallone CA. Does blood urea nitrogen level predict severity and high-risk endoscopic lesions in patients with nonvariceal upper gastrointestinal bleeding?. Canadian Journal of Gastroenterology and Hepatology. 2008;22(4):399-403.

Siddique RA. Prevalence of peptic ulcer disease among the patients with abdominal pain attending the department of medicine in Dhaka Medical College Hospital, Bangladesh. IOSR. 2014;13(1):5-20.

Sacher H, Vaidya K, Laine L. Intermittent vs continous proton pump inhibitor therapy for high risk bleeding ulcers a systemic review and meta analysis. JAMA Intern Med. 2014;174(11):1755-62.

Chen ZJ, Freeman ML. Management of upper gastrointestinal bleeding emergencies: evidence-based medicine and practical considerations. World J Emerg Med. 2011;2(1):5.

Javid G, Masoodi I, Zargar SA, Khan BA, Yatoo GN, Shah AH, et al. Omeprazole as adjuvant therapy to endoscopic combination injection sclerotherapy for treating bleeding peptic ulcer. Am J Med. 2001 Sep 1;111(4):280-4.

Madangopalan N, Balakumar K, Jaishreegajraj A. Epidemiology of peptic ulcer in India. Ind. J. Gastroenterol. 1985:3-6.

Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am. 2008;92(3):491-509.

Singh SP, Panigrahi MK. Spectrum of upper gastrointestinal hemorrhage in coastal Odisha. Tropical Gastroenterology. 2013;34(1):14-7.