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Efficacy of an intravenous proton pump inhibitor after endoscopic therapy with epinephrine injection for peptic ulcer bleeding in patients with uraemia: a case-control study |
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| Authors: | G.-Y. TSENG,&dagger ,C.-T. FANG&Dagger ,H.-J. LIN§ ,H.-B. YANG¶ ,G.-C. TSENG,P.-C. WANG&dagger &dagger ,P.-C. LIAO&Dagger &Dagger ,Y.-T. CHENG&Dagger ,& C.-H. HUANG&Dagger |
| Affiliation: | Division of Gastroenterology, Department of Medicine, Ton-Yen General Hospital, Hsin-Chu, Taiwan;;Nursing Department, Yuan-Pei University, Hsin-Chu, Taiwan;;Division of Nephrology, Department of Medicine, Ton-Yen General Hospital, Hsin-Chu, Taiwan;;Division of Gastroenterology, Department of Medicine, Changhua Christian Hospital, Changhua, Taiwan, and School of Medicine, National Yang-Ming University, Taipei, Taiwan;;Department of Pathology, Ton-Yen General Hospital, Hsin-Chu, Taiwan;;Department of Pathology, China Medical University Hospital, Tai-Chung, Taiwan;;Department of Medicine, Ton-Yen General Hospital, Hsin-Chu, Taiwan;;Department of Clinical Research, Ton-Yen General Hospital, Hsin-Chu, Taiwan |
| Abstract: | 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. Re-bleeding, volume of blood transfusion, hospital stay, need for surgery, and mortality were analysed. Results The uraemic group had similar 7-day re-bleeding rate (6/42, 14.29% vs. 6/46, 13.04%, P = 0.865) to that of non-uraemic patients, but more re-bleeding episodes beyond 7 days (4/42, 9.52% vs. 0/46, 0%, P = 0.032, OR [95% CI] = 1.105 [1.002–1.219]) and all-cause mortality (4/42 vs. 0/46 P = 0.032, OR [95% CI] = 1.105 [1.002–1.219]). The uraemic group also had more units of blood transfusion after endoscopic therapy (mean ± s.d. 4.33 ± 3.35 units vs. 2.15 ± 1.65 units, P < 0.001), longer hospital stay (mean ± s.d. 8.55 ± 8.12 days vs. 4.11 ± 1.60 days, P < 0.001) and complications during hospitalization (9/42 vs. 0/46, P = 0.001, OR [95% CI] = 1.273 [1.087–1.490]). Conclusion Endoscopic therapy with epinephrine injection plus an intravenous proton pump inhibitor can offer protection against early re-bleeding in uraemic patients with peptic ulcer bleeding, but has a limited role beyond 7 days. |
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