hold the PPI in GI Bleed?

25 Feb

interesting post from the Skeptic’s Guide to EM:

BASIC QUESTION:

Does the use of PPIs (e.g. 80mg pantoprazole IV bolus followed by an 8mg/hr drip) prior to endoscopy in acute upper GI bleeds change patient oriented outcomes?

 

 

10-SECOND TAKEAWAY:

bleeding usually from peptic ulcer

seemed reasonable and has been common practice to lower the gastric acid

 

Mortality (six trials n=2223) NO DIFFERENCE

Rebleeding (five trials n=2,121) NO DIFFERENCE

Surgery (five trials n=2,165) NO DIFFERENCE

Active bleed at scope (four trials n=1,332) 8.6% PPI vs. 11.7% placebo

 

“Applying a costly treatment that does not seem to positively effect clinically important end points like mortality, need for surgery or re-bleeding does not seem wise.  Proton pump inhibitors may be required but this data does not support the routine use of them before endoscopy.”

 

References: post; picture

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