Inhibidor de la bomba de protones orales de alta dosis es tan eficaz como la administración intravenosa en el aspecto de aumentar el pH intragástrico y la reducción de nuevas hemorragias después del tratamiento endoscópico de úlceras pépticas sangrantes

BACKGROUND/AIMS: The use of proton pump inhibitor (PPI) prevents rebleeding by elevating intragastric pH in patients with bleeding peptic ulcers after hemostasis has been achieved. We assessed that the high-dose oral pantoprazole is as effective as high-dose intravenous pantoprazole on 24-hour intragastric pH and determined their ability to prevent rebleeding after having achieved initial hemostasis to patients with active bleeding or nonbleeding visible vessels. METHODS: Forty patients with bleeding peptic ulcers, who had obtained initial hemostasis, were enrolled in this randomized controlled trial. In the high-dose oral pantoprazole group (n=20), 40 mg of pantoprazole was given orally twice daily for 5 days. In the high-dose intravenous pantoprazole group (n=20), 80 mg intravenous bolus of pantoprazole was given, followed by 8 mg/hour of continuous infusion daily for 3 days. Thereafter, 40 mg of pantoprazole was given orally once daily for 8 weeks. A pH meter was inserted in each patients' fundus and then the pantoprazole was administered within 5 minutes (10 patients in oral group and intravenous group, respectively). RESULTS: The two groups were similar with respect to all background variables. Rebleeding occurred in 2 patients 810%) in the intravenous group and did not occur in the oral group by day 30 after enrollment (p=0.154). There was no significant difference in terms of therapeutic endoscopic sessions ( 1 vs. 1.18=0.53), surgery (0% vs. 0%), mortality (0% vs. 5.9%), and mean number of units of blood transfused (1.9 vs. 1.9 pints). Pantoprazole maintained the mean gastric pH for 24 hours at the level of 4.8 ± 1.4 in the oral group, as compared with 5.7 ± 0.3 in the intravenous group (p<0.001). The duration of intragastric pH higher than 6.0 was longer in the intravenous group (64.4% vs. 38.3%) than that of the oral group (43.7% ± 26.2%), p<0.005). But, after 7 hours of administration, there was no significant difference in the mean gastric pH (oral; 5.6 ± 0.6 vs. Intravenous, 5.8 ± 0.2, p=0.554). CONCLUSIONS: The high-dose oral pantoprazole is as effective as intravenous administration in increasing intragastric pH and reducing rebleeding episodes in patients with bleeding peptic ulcers after successful endoscopic therapy.