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proton pump inhibitors infusion vs bolus

Hamita Sachar, Keta Vaidya, Loren Laine
IMPORTANCE: Current guidelines recommend an intravenous bolus dose of a proton pump inhibitor (PPI) followed by continuous PPI infusion after endoscopic therapy in patients with high-risk bleeding ulcers. Substitution of intermittent PPI therapy, if similarly effective as bolus plus continuous-infusion PPI therapy, would decrease the PPI dose, costs, and resource use. OBJECTIVE: To compare intermittent PPI therapy with the currently recommended bolus plus continuous-infusion PPI regimen for reduction of ulcer rebleeding...
November 2014: JAMA Internal Medicine
Joseph J Y Sung, Bing-Yee Suen, Justin C Y Wu, James Y W Lau, Jessica Y L Ching, Vivian W Y Lee, Philip W Y Chiu, Kelvin K F Tsoi, Francis K L Chan
OBJECTIVES: The use of intravenous proton-pump inhibitors (PPIs) has shown to reduce recurrent bleeding and improve patient outcome after endoscopic hemostasis on patients with peptic ulcer. However, the efficacy of oral PPI is uncertain. Studies from Asia indicated that even oral PPI can achieve the same therapeutic effect. This study is designed to compare the efficacy of high-dose intravenous PPI to oral PPI in preventing recurrent bleeding after endoscopic hemostasis. METHODS: This is a single-center, randomized-controlled, double-blind, and double-dummy study...
July 2014: American Journal of Gastroenterology
Ignacio Neumann, Luz M Letelier, Gabriel Rada, Juan Carlos Claro, Janet Martin, Colin W Howden, Yuhong Yuan, Grigorios I Leontiadis
BACKGROUND: Treatment with proton pump inhibitors (PPIs) improves clinical outcomes in patients with peptic ulcer bleeding. However, the optimal dose and route of administration of PPIs remains controversial. OBJECTIVES: To evaluate the efficacy of different regimens of PPIs in the management of acute peptic ulcer bleeding using evidence from direct comparison randomized controlled trials (RCTs).We specifically intended to assess the differential effect of the dose and route of administration of PPI on mortality, rebleeding, surgical intervention, further endoscopic haemostatic treatment (EHT), length of hospital stay, transfusion requirements and adverse events...
June 12, 2013: Cochrane Database of Systematic Reviews
A A Mostaghni, S A Hashemi, S T Heydari
BACKGROUND: Proton pump inhibitors (PPIs) decrease the rate of rebleeding following endoscopic hemostatic therapy in patients with bleeding peptic ulcers. This study compares the efficacy of oral omeprazole vs intravenous pantoprazole in decrease of rebleeding of peptic ulcer patients. METHODS: One hundred and six patients with high risk peptic ulcer were randomized to receive either oral omeprazole (80 mg BID for 3 days) or IV pantoprazole (80 mg bolus and 8 mg/hour infusion for 3 days) followed by omeprazole (20 mg each day for 30 days)...
July 2011: Iranian Red Crescent Medical Journal
C-C Chen, J-Y Lee, Y-J Fang, S-J Hsu, M-L Han, P-H Tseng, J-M Liou, F-C Hu, T-l Lin, M-S Wu, H-P Wang, J-T Lin
BACKGROUND: The optimal dosage of intravenous proton pump inhibitors (PPIs) for the prevention of peptic ulcer rebleeding remains unclear. AIM: To compare the rebleeding rate of high-dose and standard-dose PPI use after endoscopic haemostasis. METHODS: A total of 201 patients with bleeding ulcers undergoing endoscopic treatment with epinephrine injection and heater probe thermocoagulation were randomised to receive a high-dose regimen (80 mg bolus, followed by pantoprazole 8 mg/h infusion, n = 100) or a standard-dose regimen (pantoprazole 40 mg bolus daily, n = 101)...
April 2012: Alimentary Pharmacology & Therapeutics
Chih-Hung Wang, Matthew Huei-Ming Ma, Hao-Chang Chou, Zui-Shen Yen, Chih-Wei Yang, Cheng-Chung Fang, Shyr-Chyr Chen
BACKGROUND: High-dose proton pump inhibitors (PPIs) (80-mg bolus, followed by 8-mg/h continuous infusion for 72 hours) have been widely studied and used. However, to date no concrete evidence has shown that high-dose PPIs are more effective than non-high-dose PPIs. METHODS: We performed a literature search for randomized controlled trials that compared the use of high-dose PPIs vs non-high-dose PPIs in patients with bleeding peptic ulcer and determined their effects on rebleeding, surgical intervention, and mortality...
May 10, 2010: Archives of Internal Medicine
Yao-Chun Hsu, Chin-Lin Perng, Tzeng-Huey Yang, Chaur-Shine Wang, Wei-Lun Hsu, Huei-Tang Wu, Yang-Chih Cheng, Ming-Feng Chiang, Hwai-Jeng Lin
AIM: The optimal dosage of proton pump inhibitor in bleeding peptic ulcers remains controversial. The aim was to compare the clinical effectiveness of two doses of infusional pantoprazole in peptic ulcer bleeding. METHODS: Peptic ulcer patients (n= 120) with bleeding stigmata were enrolled after successful endoscopic therapy. After an initial bolus injection of 80 mg pantoprazole, patients were randomized to receive continuously infused pantoprazole at either 192 mg day(-1) or 40 mg every 6 h (i...
March 2010: British Journal of Clinical Pharmacology
C Sfarti, C Stanciu, Camelia Cojocariu, Anca Trifan
UNLABELLED: Helicobacter pylori (H. pylori) is the main etiologic factor for duodenal ulcer (DU). Bleeding is still a frequent and sometimes severe complication, with unacceptable mortality despite modern therapeutic modalities. The importance of diagnosing and treating H. pylori infection in bleeding DU is underlined by the fact that eradication therapy is effective in preventing recurrent bleeding. The aim of this study was to evaluate the prevalence of H. pylori infection by means of 13C urea breath test (13C-UBT) in patients with bleeding DU...
July 2009: Revista Medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti Din Iaş̧i
G-Y Tseng, C-T Fang, H-J Lin, H-B Yang, G-C Tseng, P-C Wang, P-C Liao, Y-T Cheng, C-H Huang
BACKGROUND: Patients with peptic ulcer bleeding and uraemia are prone to re-bleeding. AIM: To compare the efficacy of an intravenous proton pump inhibitor in treating peptic ulcer bleeding in patients with uraemia and those without uraemia. METHODS: High-risk peptic ulcer bleeding patients received endoscopic therapy with epinephrine (adrenaline) injection plus intravenous omeprazole (40 mg bolus followed by 40 mg infusion every 12 h) for 3 days...
August 15, 2009: Alimentary Pharmacology & Therapeutics
Joseph J Y Sung, Alan Barkun, Ernst J Kuipers, Joachim Mössner, Dennis M Jensen, Robert Stuart, James Y Lau, Henrik Ahlbom, Jan Kilhamn, Tore Lind
BACKGROUND: Use of proton-pump inhibitors in the management of peptic ulcer bleeding is controversial because discrepant results have been reported in different ethnic groups. OBJECTIVE: To determine whether intravenous esomeprazole prevents recurrent peptic ulcer bleeding better than placebo in a multiethnic patient sample. DESIGN: Randomized trial conducted between October 2005 and December 2007; patients, providers, and researchers were blinded to group assignment...
April 7, 2009: Annals of Internal Medicine
Akihiro Tajima, Kazuhito Koizumi, Kazuyoshi Suzuki, Naoko Higashi, Morio Takahashi, Tadahito Shimada, Akira Terano, Hideyuki Hiraishi, Hajime Kuwayama
Peptic ulcer disease (PUD) is one of the main lesions responsible for upper gastrointestinal (GI) bleeding, as well as esophageal varices and Mallory-Weiss tear. Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs)/aspirin are the major responsible causes. In cases of upper GI bleeding, urgent endoscopy is performed after stabilization of vital signs. There are several modalities for controlling bleeding in PUD, such as ethanol injection or hypertonic saline with epinephrine. Recurrent bleeding occurs in 20% of patients after endoscopic therapy...
December 2008: Journal of Gastroenterology and Hepatology
Angelo Andriulli, Silvano Loperfido, Rosaria Focareta, Pietro Leo, Fabio Fornari, Antonietta Garripoli, Paolo Tonti, Sergio Peyre, Antonio Spadaccini, Riccardo Marmo, Antonio Merla, Alessandro Caroli, Gian Battista Forte, Angelo Belmonte, Giovanni Aragona, Gianni Imperiali, Fabrizio Forte, Fabio Monica, Nazario Caruso, Francesco Perri
BACKGROUND: The most effective schedule of proton pump inhibitor (PPI) administration following endoscopic hemostasis of bleeding ulcers remains uncertain. METHODS: Patients with actively bleeding ulcers and those with nonbleeding visible vessel or adherent clot were treated with epinephrine injection and/or thermal coagulation, and randomized to receive intravenous PPIs according to an intensive regimen (80 mg bolus followed by 8 mg/h as continuous infusion for 72 h) or a standard regimen (40 mg bolus daily followed by saline infusion for 72 h)...
December 2008: American Journal of Gastroenterology
A Garrido, A Giráldez, C Trigo, E Leo, A Guil, J L Márquez
OBJECTIVE: To compare two regimens of pantoprazole administered intravenously in patients with ulcerative gastrointestinal bleeding (UGB), and a high risk of presenting with persitent or recurrent hemorrhage. MATERIAL AND METHOD: Patients were randomized into two groups: group 0--treatment with a 80 mg bolus of pantoprazole administered intravenously, followed by continuous infusion of 8 mg/h for 72 hours; group 1--treatment with 40 mg of pantoprazole administered intravenously on a daily basis...
August 2008: Revista Española de Enfermedades Digestivas
E Esrailian, I M Gralnek, D Jensen, L Laine, G S Dulai, G Eisen, B M R Spiegel
BACKGROUND: When faced with the same facts, physicians often make different decisions. Aim To perform a survey to measure the process of care and variations in decision-making in nonvariceal upper gastrointestinal tract haemorrhage (NVUGIH) and compare results between experts and non-experts. METHODS: We administered a vignette survey to elicit knowledge and beliefs about NVUGIH, including 13 'best practice' guidelines. We compared guideline compliance between experts and non-experts...
November 15, 2008: Alimentary Pharmacology & Therapeutics
Loren Laine, Abbid Shah, Shahrooz Bemanian
BACKGROUND & AIMS: Intravenous bolus plus infusion proton pump inhibitor (PPI) therapy is recommended for patients with bleeding ulcers and higher risk stigmata. If frequent oral dosing of PPIs provided similar antisecretory effect, this might be preferred based on ease and cost. METHODS: Patients presenting with overt bleeding due to ulcers had intragastric pH probes placed after endoscopy and baseline pH recorded. They were randomly assigned to intravenous lansoprazole (90-mg bolus followed by 9-mg/h infusion) or oral lansoprazole (120-mg bolus followed by 30 mg every 3 hours)...
June 2008: Gastroenterology
Jasmohan S Bajaj, Kulwinder S Dua, Kristin Hanson, Kenneth Presberg
Proton pump inhibitors (PPIs) reduce the rate of rebleeding in patients with nonvariceal upper GI bleed (NVGIB). Oral (PO) and intravenous (IV) pantoprazole are equipotent in raising gastric pH. We conducted a pilot study comparing the efficacy of PO vs. IV pantoprazole for reducing rebleeding after NVGIB. Patients with NVGIB were randomized to receive PO (80 mg BID for 3 days) or IV (80-mg IV bolus and 8 mg/hr infusion for 3 days) pantoprazole followed by pantoprazole, 40 mg PO BID, for 30 days. All patients underwent endoscopy within 24 hr and endotherapy was applied where necessary...
September 2007: Digestive Diseases and Sciences
M Simon-Rudler, J Massard, B Bernard-Chabert, V DI Martino, V Ratziu, T Poynard, D Thabut
UNLABELLED: High-dose omeprazole reduces the rate of recurrent bleeding after endoscopic treatment of peptic ulcer bleeding. However, the effectiveness of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding has never been shown. AIM: To compare the benefits of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding. METHODS: We reviewed the medical files of patients admitted between 1997 and 2004 for high-risk peptic ulcer bleeding who had undergone successful endoscopic treatment...
April 15, 2007: Alimentary Pharmacology & Therapeutics
C Fu, Y Mishra, I Ramzan
We examined the effect of proton pump inhibitor omeprazole on neuromuscular paralysis induced with either nondepolarizing or depolarizing neuromuscular blocking drugs in anesthetized and mechanically ventilated rats. Neuromuscular paralysis, as judged by tibialis anterior muscle twitch tension in response to sciatic nerve stimulation, was maintained at about 50% with intravenous (i.v.) bolus and infusion regimens of either atracurium or succinylcholine. Omeprazole, 0.5, 1, and 10 mg/kg i.v., was then administered at 10-min intervals while the infusion of the neuromuscular blocker was continued...
March 1994: Anesthesia and Analgesia
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