Ayoub Fares, Khullar Vikas, Banerjee Debdeep, Stoner Patrick, Lambrou Tiffany, Westerveld Donevan R, Hanayneh Wissam, Kamel Amir Y, Estores David
Department of Medicine, University of Florida, Gainesville, FL 32608, USA.
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, FL 32608, USA.
Gastroenterology Res. 2018 Jun;11(3):200-206. doi: 10.14740/gr1011w. Epub 2018 May 31.
After inpatient management of upper gastrointestinal bleeding (GIB) due to peptic ulcer disease (PUD), oral proton pump inhibitor (PPI) therapy is recommended at discharge to decrease rebleeding risk and improve ulcer healing. Our aim is to determine whether once-daily oral PPI dosing at hospital discharge is associated with inferior 30-day rebleeding outcomes as compared to twice-daily dosing.
We retrospectively identified 233 patients admitted with signs and symptoms of upper GIB found to be due to PUD on upper endoscopy. After inpatient management, patients discharged on once-daily oral PPI were compared to those discharged on twice-daily therapy. We utilized propensity score matching based on Rockall scores to ensure the two groups were closely matched in terms of their baseline rebleeding risk. Primary outcome was the incidence of rebleeding within 30 days. Secondary outcomes were all-cause mortality, blood transfusion requirement, requirement for interventional radiology or surgery.
Overall, 49 patients were discharged on once-daily and 184 on twice-daily PPI. Recurrent bleeding occurred in 18 patients (7.7%) within 30 days. There was no statistically significant difference in recurrent bleeding rates between once-daily (n = 7, 14.3%) as compared to twice-daily PPI (n = 11, 6%) (P = 0.053). In a 1:1 propensity score matched analysis, there was no statistically significant difference in 30-day recurrent bleeding rate between groups (14% once-daily vs. 4% twice-daily, P = 0.159). There were no differences in secondary outcomes.
Once-daily oral PPI dosing at hospital discharge was not associated with inferior outcomes compared to twice-daily dosing in patients hospitalized for upper GIB due to PUD.
因消化性溃疡病（PUD）导致上消化道出血（GIB）的患者经住院治疗后，出院时建议口服质子泵抑制剂（PPI）以降低再出血风险并促进溃疡愈合。我们的目的是确定出院时每日一次口服PPI给药与每日两次给药相比，30天再出血结局是否较差。
我们回顾性识别了233例因上消化道出血的体征和症状入院且经上消化道内镜检查发现为PUD所致的患者。住院治疗后，将出院时接受每日一次口服PPI治疗的患者与接受每日两次治疗的患者进行比较。我们基于罗卡尔评分使用倾向评分匹配，以确保两组在基线再出血风险方面紧密匹配。主要结局是30天内再出血的发生率。次要结局是全因死亡率、输血需求、介入放射学或手术需求。
总体而言，49例患者出院时接受每日一次PPI治疗，184例接受每日两次PPI治疗。18例患者（7.7%）在30天内出现复发性出血。每日一次PPI治疗组（n = 7，14.3%）与每日两次PPI治疗组（n = 11，6%）的复发出血率无统计学显著差异（P = 0.053）。在1:1倾向评分匹配分析中，两组间30天复发出血率无统计学显著差异（每日一次为14%，每日两次为4%，P = 0.159）。次要结局方面无差异。
因PUD导致上消化道出血住院的患者，出院时每日一次口服PPI给药与每日两次给药相比，结局并不较差。
