Proton pump inhibitors (PPIs) after endoscopic haemostasis reduce rebleeding rates in patients with high-risk acute non-variceal upper gastrointestinal (GI) bleeding.
Many advocate the use of PPIs prior to endoscopy, although its incremental benefit is unproven.
Dr Keyvani and colleagues from Canada determined if providing PPIs before endoscopy reduces adverse GI outcomes in acute non-variceal upper GI bleeding patients.
The researchers performed a retrospective review to identify patients presenting to 2 tertiary care centres between 1999 and 2004.
The researchers compared 132 subjects receiving PPI therapy before endoscopy with 253 not receiving pre-endoscopic PPI therapy.
| Mortality was lower in patients receiving pre-endoscopic PPI|
|Alimentary Pharmacology & Therapeutics|
The team's primary outcome measure was the development of any adverse bleeding outcome.
Adverse outcomes included rebleeding, surgery for control of bleeding, in-hospital mortality, readmission within 30 days for upper GI bleeding.
Patients receiving pre-endoscopic PPI therapy were significantly less likely to develop adverse outcomes compared with those not given pre-endoscopic PPIs.
The team noted that rebleeding, and upper gastrointestinal surgery were lower in patients receiving pre-endoscopic PPI.
In addition, mortality and length of hospital stay were lower in patients receiving pre-endoscopic PPI.
Dr Keyvani's team concludes, “The use of PPIs before endoscopy significantly reduces the risk of developing adverse gastrointestinal outcomes in patients with acute non-variceal upper gastrointestinal bleeding.”
“Future studies are required to better characterize this relationship.”