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| |  Continuous IV Pantoprazole Better Than Continuous Omeprazole In Combined Regimen With Endoscopic Injection for Upper Nonvariceal Bleeding: Presented at UEGW By Chris Berrie BERLIN, GERMANY -- October 25, 2006 -- Endoscopic haemostasis combined with pantoprazole is more efficacious than endoscopic haemostasis combined with omeprazole for reducing non-variceal bleeding in patients with peptic ulcer, according to a randomised, double-blind study presented here at the United European Gastroenterology Week (UEGW). Acute, non-radical upper gastrointestinal bleeding is associated with mortality rates of 6% to 14%, and the risk for recurrent bleeding is increased in patients with major bleeding and endoscopic evidence of peptic ulcer with recent stigmata. In such cases, endoscopic haemostasis can control bleeding and reduce bleeding rates, although it is a highly pH-dependent process that can show severe impairment at low pH. On the basis that this could improve the clinical efficacy under hypersecretory conditions, Nabil J. Chahin, MD, PhD, clinical professor of gastroenterology and director, gastroenterology and digestive endoscopy unit, Hesperia Hospital, Modena, Italy, and colleagues conducted a study in which his research team compared the effects of continuous infusion of pantoprazole and omeprazole after endoscopic haemostasis of nonvariceal bleeding in patients with peptic ulcer Dr. Chahin, the study's principal investigator, discussed the findings of this study in a presentation on October 24th. The proton-pump inhibitor (PPI) pantoprazole has been shown to bind particularly tightly to the proton pump, providing a more lengthy inhibition of gastric acid secretion than other PPIs. Omeprazole is also PPI but it has different proton pump-binding characteristics. The main entry criterion was for patients with endoscopically confirmed oesophageal, gastric, duodenal or stomach ulcers, Dieulafoy's lesions and stigmata of recent bleeding (as defined by the Forrest classification). Patients were excluded if they had massive bleeding and persistent shock with fresh blood in the gastrointestinal tract that necessitated emergency surgery. Endoscopic evidence of bleeding from varices or tumours also led to exclusion. All of the 164 patients enrolled in the study were treated with endoscopic injection using 1:10,000 adrenaline (range, 8-15 mL). Within 2 hours of this endoscopic procedure, patients were randomised to receive either pantoprazole or omeprazole. The PPIs were both administered as 80 mg bolus doses followed by continuous IV infusion at 8 mg/hour for 3 days. Mean age among the 81 pantoprazole patients was 54.0 years and 53 years among the 83 omeprazole patients (male, 63.0% and 62.6%, respectively) Demographic and baseline characteristics monitored were similar between the 2 treatment groups, including clinical presentation (haematemesis, melena, haematemesis/ melena), medications (nonsteroidal anti-inflammatory drugs, aspirin, ticlopidine), vital signs (pulse rate, blood pressures), ulcer sites (oesophagus, stomach, duodenal, stomal) and comorbid illnesses (cardiac, pulmonary, renal). Combined patient bleeding patterns at baseline were arterial spurting (n = 28), active oozing (n = 42), a visible vessel (n = 46) and an adherent clot (n = 48); there were no significant differences between these patient bleeding patterns across the 2 treatment groups. Treatment outcomes showed significant lower rebleeding rates with pantoprazole than omeprazole (3.7% vs 10.8%, respectively; P = .022). Pantoprazole also had significantly lower blood transfusion rates (25% vs 50%; P < .001) and shorter mean hospital stays (4.6 vs 7.1 days; P < .001). Pantoprazole reduced the need for surgery for uncontrolled bleeding (1 patient vs 4 patients), although this did not reach statistical significance (P = .16). Similarly, significance was not reached mortality rates: 1 patient in the pantoprazole group died after surgery as a result of a comorbid illness, and 2 patients in the omeprazole group died after surgery because of rebleeding. Dr. Chahil said that the use of endoscopic haemostasis combined with pantoprazole is more efficacious than when combined with omeprazole to reduce rebleeding rates as well as surgery, blood transfusions and hospital stays in patients with nonvariceal bleeding.
[Presentation title: Endoscopic Injection Plus Continuous IV Pantoprazole Versus Endoscopic Injection Plus Continuous Omeprazole for the Treatment of Upper Non-Variceal Bleeding. Abstract Tues-G-232]
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