Randomly selected patients endoscoped for non-variceal upper gastrointestinal bleeding at 18 community and tertiary care centers between 1999 and 2002 were analyzed.
Covariates and outcomes were defined a priori and 30-day follow-up obtained, with logistic regression models used by researchers, working at several universities across Canada, to identify predictors of outcomes.
A total of 1869 patients were included, with an average age of 66 ± 17 years, 38% of whom were female. All had 2.5 ± 1.6 comorbid conditions, a hemoglobin of 96 ± 27 g/L, with 54% having received a mean of 2.9 ± 1.7 units of blood.
| Decreased rebleeding was associated with PPI use|
|American Journal of Gastroenterology|
In 76% of cases, patients underwent endoscopy within 24 hours. Ulcers were most commonly noted (55%).
High risk endoscopic stigmata and endoscopic therapy were reported in 37%, while rebleeding, surgery, and mortality rates were 14.1%, 6.5% and 5.4%, respectively.
The researchers found the use of proton pump inhibitors (85% of patients, mean daily dose 56 ± 53 mg) was significantly and independently associated with decreased rebleeding in all patients, regardless of endoscopic stigmata.
Decreased rebleeding was also associated with endoscopic hemostasis in patients with high-risk stigmata.
Both proton pump inhibitor use and endoscopic therapy were also each independently associated with decreased mortality in patients with high-risk stigmata.
Commenting on their findings, Alan Barkun, one of the report authors, said that the results appear to confirm the protective role of endoscopic therapy in patients with high-risk stigmata.
He added that the results suggest that acute use of proton pump inhibitors may be associated with a reduction of rebleeding in all patients, and lower mortality in patients with high-risk stigmata.
"Independent prospective validation of these observational findings is now required", he said.