Matsuda Hidetaka, Nosaka Takuto, Akazawa Yu, Saito Yasushi, Ozaki Yoshihiko, Takahashi Kazuto, Naito Tatsushi, Ofuji Kazuya, Ohtani Masahiro, Hiramatsu Katsushi, Nakamoto Yasunari
Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Gastroenterol Res Pract. 2020 Aug 6;2020:7168621. doi: 10.1155/2020/7168621. eCollection 2020.
We retrospectively examined the relationship between daily proton pump inhibitor (PPI) use and severity of upper gastrointestinal bleeding (UGIB), mainly in the elderly.
We included 97 patients with nonvariceal UGIB diagnosed at our hospital from January 2012 to October 2017. Bleeding severity was assessed using the shock index (SI) and estimated bleeding volume; 49 patients met the criterion for the mild group and 48 for the moderate/severe group. The effect of PPI use on bleeding severity was compared between the groups. The relationships of PPI use and dose with the clinical symptoms of UGIB were also analyzed.
Among the 97 patients, 17 (17.5%) habitually used PPIs. The rate of habitual PPI use was significantly higher in the mild group, indicating as an independent factor contributing to a reduction in the severity of UGIB in a multiple logistic regression analysis (30.6% vs. 4.2%; OR 10.147; 95% CI 2.174-47.358, < 0.01). When analyzing data for a subgroup of patients older than 75 years, we found the protective PPI effect to be even higher in the mild UGIB group than in the moderate/severe group (37.0% vs. 5.6%; OR 10.000; 95% CI 1.150-86.951, < 0.05). Conversely, we found no association between PPI prescription and UGIB symptoms in patients younger than 75 years. The mean estimated bleeding volume and SI in the 17 habitual PPI users were both significantly less than those among the 80 nonhabitual users, respectively ( < 0.05). The proportion of patients with mild UGIB was similar between the low- and high-dose PPI users.
Particularly in elderly patients with nonvariceal UGIB, habitual PPI use can alleviate the clinical symptoms of UGIB by suppressing the volume of bleeding, regardless of the adapted dose of PPIs.
我们回顾性研究了每日使用质子泵抑制剂（PPI）与上消化道出血（UGIB）严重程度之间的关系，主要针对老年患者。
我们纳入了2012年1月至2017年10月在我院诊断为非静脉曲张性UGIB的97例患者。使用休克指数（SI）和估计出血量评估出血严重程度；49例患者符合轻度组标准，48例符合中度/重度组标准。比较两组中使用PPI对出血严重程度的影响。还分析了PPI使用及剂量与UGIB临床症状的关系。
97例患者中，17例（17.5%）习惯性使用PPI。轻度组习惯性使用PPI的比例显著更高，在多因素逻辑回归分析中表明这是导致UGIB严重程度降低的一个独立因素（30.6%对4.2%；比值比10.147；95%置信区间2.174 - 47.358，P < 0.01）。在分析75岁以上患者亚组的数据时，我们发现轻度UGIB组中PPI的保护作用甚至高于中度/重度组（37.0%对5.6%；比值比10.000；95%置信区间1.150 - 86.951，P < 0.05）。相反，我们发现75岁以下患者中PPI处方与UGIB症状之间没有关联。17例习惯性使用PPI的患者的平均估计出血量和SI均分别显著低于80例非习惯性使用者（P < 0.05）。低剂量和高剂量PPI使用者中轻度UGIB患者的比例相似。
特别是在老年非静脉曲张性UGIB患者中，习惯性使用PPI可通过抑制出血量来缓解UGIB的临床症状，无论PPI的适用剂量如何。
