LOW DOSE PPI AS EFFECTIVE AS HIGH DOSE

Low-Dose PPI as Effective as High-Dose for Peptic Ulcer Bleeding

NEW YORK (Reuters Health) Jan 01 - Low-doses of proton pump inhibitors (PPIs) are as effective as high-dose PPIs for the prevention of recurrent bleeding after endoscopic hemostasis of peptic ulcer bleeding, according to a report in the December American Journal of Gastroenterology.

"The message is straightforward: use the standard does of PPI in conjunction with a successful endoscopic therapy," Dr. Angelo Andriulli from "Casa Sollievo della Sofferenza" Hospital, San Giovanni, Italy, told Reuters Health.

Dr. Andriulli and colleagues compared low-dose (40 mg bolus daily) and intensive (80 mg bolus followed by 8 mg/h for 72 hours) PPI regimens for the prevention of rebleeding, surgery, and death in 474 patients with high-risk bleeding peptic ulcers in whom successful endoscopic hemostasis was achieved.

Bleeding recurred in 11.8% of patients in the intensive regimen group and in 8.1% of the patients in the standard regimen group (p=0.18), the authors report.

Rebleeding rates did not differ significantly between the two treatment groups or by type of ulcer (gastric or duodenal), the report indicates.

A similar number of units of blood were transfused in the two groups, the researchers note, as were the proportions of patients who required 2 or more units of blood transfused.

Five patients in each group died, including 3 in each group in whom the cause of death was linked to the bleeding event.

"The next study should compare the oral route versus the IV administration of PPI from the start of the bleeding," Dr. Andriulli said. "Moreover, the PPI dose should be the standard one, i.e., two tablets orally."

Although the elimination of the continuous PPI infusion does represent a step forward in terms of limiting resource utilization, "there are far greater potential gains if there were definitive proofs of the equivalence of an oral PPI regimen, which may facilitate earlier discharge of higher risk patients with upper gastrointestinal bleeding," write Dr. Laura E. Targownik and Dr. Peter A. Thomson from University of Manitoba, Winnipeg, in a related editorial.

They conclude, "Perhaps we will soon know whether the benefits provided by IV dosing over oral dosing are also illusionary."

Dr. Andriulli expressed surprise at the difficulty he encountered in publishing these findings. "My personal explanation for the rebuttal was that we were not backed by a pharmaceutical company in the planning, executing, and collecting of the results."

However, 11 investigators in Italy have embarked on a multicenter with similar data from previous placebo-controlled trials, and so far contradict current recommendations put forward by consensus guidelines. "This raises several points on the way referees are selecting and judging submissions," the researcher said