Risk Factor Analysis for Recurrent Bleeding in High-risk Bleeding Peptic Ulcers after Endoscopic Therapy
| Autor: | Chieh-Chang Chen, 陳介章 |
|---|---|
| Rok vydání: | 2011 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 99 Background Acute peptic ulcer bleeding remains the most common cause of acute upper gastrointestinal bleeding. Endoscopic hemostasis has been documented to be effective in decreasing rebleeding, need for surgery, and decreasing hospitalization days. Studies showed a high dose intravenous proton pump inhibitor infusion after endoscopic hemostasis reduced recurrent ulcer bleeding. It was controversial whether an adjuvantive use of standard-dose proton pump inhibitor therapy after endoscopic therapy had similar benefit. In addition, few literatures discussed risk factors of recurrent bleeding in the era of endoscopic therapy and proton pump inhibitors Methods Patients with actively bleeding ulcers or ulcers with non-bleeding visible vessel were treated with epinephrine injection and thermal coagulation, and randomized to receive intravenous PPIs according to a high-dose regimen (pantoprazole 80 mg bolus followed by 8 mg/h as continuous infusion for 72 h) or a standard-dose regimen (pantolprazole 40 mg bolus daily for 72 h). After 72 hours, all patients were given 40 mg pantoprazole daily orally for 27 days. The primary end point was recurrent bleeding within 30days after endoscopy. Results We enrolled 201 patients, 100 patients in the high-dose group and 101 patients in standard-dose group. Bleeding recurred within 30 days in 6 patients (6.2%, 95% CI 1.3% – 11.1%) in the high-dose group, as compared with 5 patients (5.2%, 95% CI 0.6% – 9.7%) in the standard-dose group (P=0.77). Mean units of blood transfused were 2.9 ± 6.2 in the high-dose and 1.6 ± 2.2 in the standard-dose group (P = 0.05). The duration of hospital stay was ≦ 5 days for 55 (56.7%) and 57 patients (59.3%) in the high- and standard-dose groups (P = 0.70). There were fewer surgical interventions or transcatheter arterial embolization in the standard- versus high-dose group (0 vs 1, P = 0.32). Three (3.1%) patients in the high-dose group and 1 (1%) patients died within 30 days after endoscopy (P = 0.32). The stepwise Cox regression analysis showed dialysis, hematemesis, chronic obstructive pulmonary disease (hazard ratio: 37.15, 10.07, 9.12, 95% confidence interval (CI): 6.76 - 204.14, 2.07 – 49.01, 1.66 – 50.00, respectively) were independent risk factors for recurrent bleeding and Helicobacter pylori (H. pylori) infection was associated with lower risk of recurrent bleeding (hazard ratio: 0.20, 95% CI: 0.04 – 0.94). Conclusions Following combined endoscopic hemostasis of bleeding ulcers, standard-dose pantoprazole infusion is as effective as a high-dose regimen in reducing the risk of recurrent bleeding. Dialysis, hematemesis, chronic obstructive pulmonary disease, and H. pylori negative ulcer, but no proton pump inhibitor dosage, are independent factors for recurrent bleeding. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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