Author/Authors :
Gashi, Zaim UCC,Clinic of Internal diseases - Service of Gastroenterology, Kosovo , Joksimovic, Nenad UHC, Clinic of Gastroenterology, Macedonia , Dragusha, Gani UCC, Clinic of Internal diseases - Service of cardiology, Kosovo , Bakalli, Aurora UCC, Clinic of Internal diseases - Service of cardiology, Kosovo
Abstract :
Background: Nowadays PPI present cornerstone in the medical therapy ofbleeding peptic ulcer. Controlled pantoprazole data in peptic ulcer bleedingare few. Aim: To compare the effect of intravenous (iv) pantoprazole (PPI)with iv ranitidine (H2RA) for bleeding peptic ulcers after endoscopic therapy.Methods: After endoscopic haemostasis, 122 patients were randomized to PPI 80mg + 8mg/h or H2RA 50 mg + 13mg/h, both for 72 h and to continue with oralequivalent dose of these medicaments. Patients underwent second-look endoscopyon day 3 or earlier, if clinically indicated. The primary endpoint measure was rebleedingbefore discharge and 14 days of enrollment. Secondary endpoint measuresincluded number of surgeries performed, volume of blood transfusion, mortalityrate and hospital stay. All data were statistically analyzed and a value of 0.05 orless was considered to indicate statistical significance. Results: In the group whowere treated with PPI, re-bleeding rate was evidenced in 5 patients (8.33%) and inthe groups who were treated with H2RA, re-bleeding rate was found in 9 patients(14.5%) with RR 0.27 and CI 0.12-0.60 and P 0.05. The volume of transfused bloodwas lower in the group treated with PPI compared to the group treated with H2RA(930 ml vs. 1540 ml and P 0.05). In this study there was not statistically significantdifference in the hospital stay 15.00 vs. 17.80% (9 vs. 11 patients and P 0.05), theneed for surgical intervention 5.00 vs. 6.45% (3 vs. 4 patients and P= 1.00 ) and themortality rate 1.66 vs. 3.22% (1 vs. 2 patients and P 0.05).Conclusion: A high-dosepantoprazole infusion is more effective than a ranitidine infusion for prevention ofre-bleeding after endoscopic epinephrine injection in patients with peptic ulcersand active bleeding or non-bleeding visible vessels (P 0.05). In all bleeding pepticulcer patients is needed to make the eradication of H. pylori infection with the aimto prevent re-bleeding in long term.
