Pgs9: The Cost-Effectiveness of High Dose Oral Versus Intravenous Proton Pump Inhibition in High-Risk Patients With Bleeding Peptic Ulcers Having Undergone Therapeutic Endoscopy

Barkun, Alan N.; Adam, Viviane; Kennedy, W.R.; Fallone, CA; Herba, Karl; Bardou, Marc

doi:10.1016/s1098-3015(10)63972-1

Cited by 3 publications

(5 citation statements)

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“…Zaklju~ak velikog broja studija je da je terapija visokim dozama intravenskih inhibitora protonske pumpe (80mg i.v.bolus + 8mg /h, i.v. narednih 3 dana) kod bolesnika sa visokorizi~nim endoskopskim nalazom i/ili posle endoskopske hemostaze i jeftinija i uspe{nija, nego njeno izostavljanje 16 . Takodje ovakva terapija pokazuje manji broj rekrvarenja i potrebe za operacijom od terapije sa niskim dozama PPI, koja je ~esta u praksi iz razloga {tednje (takodje i u na{oj zemlji).…”

Section: Tretman Krvarenjaunclassified

“…S druge strane podaci ukazuju i da se davanje visokih doza PPI produ'ava nepotrebno, nakon endoskopije koja nije pokazala visoko rizi~ne lezije, gde se mogu koristiti i peroralne doze PPI 15,32 . Posebno je ovakva terapija uspe{nija od terapije sa H2 blokatorima, koji danas definitivno nemaju mesta u le~enju visokorizi~nih bolesnika sa ulkusnim krvarenjem 16,30 . Endoskopija je potpuno potisnula hirurgiju u inicijalnom le~enju ve}ine bolesnika sa ulkusnim krvarenjem.…”

Section: Tretman Krvarenjaunclassified

“…Kod bolesnika koji su imali krvare}e ulkuse udru'ene sa uzimanjem NSAIL-a, sama zabrana daljeg uzimanja ovih lekova zna~ajno redukuje stopu rekrvarenja. Ako pacijenti moraju zbog osnovne bolesti da nastave sa terapijom NSAIL, po'eljno je uzimanje najmanje {tetnih lekova iz te grupe uz istovremeno uzimanje inhibitora protonske pumpe i eventualno COX-2 inhibitora 15,16,32 .…”

Section: Zaklju^akunclassified

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Surgical perspectives in treatment of bleeding peptic ulcers

Lausevic

et al. 2007

ACTA CHIR IUG

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Peptic ulcer bleeding has overall incidence of 50 to 150 on 100.000 grown-ups per year and represents cause for over 1% of all urgent hospitalization today. Despite of the evolution of the endoscopic diagnostics and haemostasis, improved intensive care and surgical treatment, overall mortality is still over 10% (operative treatment over 20%), and it almost hasn't changed over past 40 years. For more than 100 years surgery had major role in treatment of peptic bleeding ulcers, whereas nowadays it is limited to treatment of its complications. Adequate surgical treatment demands properly timed operation, safest but appropriate operation and trained surgeon. Early surgery is much better compared to the last minute surgery. At high risk rebleeding ulcer, early delayed surgery appears to be adequate, since the complications and lethal outcome are more frequent in this group.

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Section: Tretman Krvarenjaunclassified

Section: Zaklju^akunclassified

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Surgical perspectives in treatment of bleeding peptic ulcers

Lausevic

et al. 2007

ACTA CHIR IUG

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“…Barkun et al 11 found that high‐dose oral therapy (40 mg pantoprazole twice daily for 5 days) and intravenous therapy (80 mg bolus followed by 8 mg/h for 3 days) produced equivalent rates of re‐bleeding (7.3% and 5.9%) in patients with bleeding ulcers initially treated endoscopically.…”

Section: Pharmacological Therapymentioning

confidence: 99%

Management of peptic ulcer bleeding—the roles of proton pump inhibitors and Helicobacter pylori eradication

Holtmann

Howden

2004

Aliment Pharmacol Ther

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SUMMARYPeptic ulcer bleeding is associated with substantial morbidity and mortality. The goals of management are to control any active bleeding and prevent re-bleeding and then to heal the ulcer and prevent its recurrence. Initial management strategies are guided by the patient's clinical condition and endoscopic findings. Thus, treatment may consist of endoscopic and medical therapy and, sometimes, surgery. Control of acid secretion, preferably with proton pump inhibitor therapy in the initial management continues to evolve; it has also been used as both an adjunct to endoscopic therapy and as primary treatment. These agents have been found to be effective in some trials in the reduction of re-bleeding and the need for surgery, although there is no clear benefit demonstrated for overall mortality. Proton pump inhibitors have been administered either intravenously or orally in different trials. The long-term management of patients with peptic ulcer, after the initial bleeding episode, should include patient stratification based upon risk factors for ulcer recurrence (i.e. Helicobacter pylori infection, use of aspirin or nonsteroidal anti-inflammatory drugs). Elimination or modification of these risk factors reduces the risk of ulcer recurrence and, hence, of recurrent ulcer bleeding.

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“…Taking all of the above-mentioned advantages of PPIs into account, two cost simulations found that the use of PPIs was costeffective irrespective of route of administration. When the highdose intravenous route was compared with the oral route, intravenous administration was found to be slightly more effective but more costly, and neither strategy was dominant [42,43].…”

Section: Antisecretory Treatment and Helicobacter Pylori Eradicationmentioning

confidence: 99%

Gastrointestinal Bleeding

Weiss

Paugam–Burtz

2003

Endoscopy

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Epidemiology, Risk Factors, and OutcomesA trend toward a lower relative frequency of peptic ulcer disease (PUD) as the cause of upper gastrointestinal bleeding has been observed in recent years. A multicenter study in the United States confirmed this tendency, comparing data from the last 3 years with historical controls from the years 1983 ± 1992. The frequency of PUD decreased significantly from 59 % to 38 %. Effective antisecretory drugs, Helicobacter pylori eradication treatment, and newer nonsteroidal anti-inflammatory drugs (NSAIDs) are all probably responsible for this decline. The frequency of variceal bleeding increased to a lesser extent, but also significantly, from 12 % to 16 %. Probably the most striking finding was an increase in the frequency of erosive esophagitis, from 4.3 % to 12.9 %; the authors were not able to explain this increase. The frequencies of other causes remained at a similar level to that seen before, except for gastric/duodenal erosions (with a decline from 4.4 % to 1.7 %) and Dieulafoy's lesions (with an increase from 0.6 % to 2.3 %); however, these changes were not significant. A significant improvement in almost all outcome measures (rebleeding, surgery, and death rates) in all groups of patients (PUD, varices, others) was observed in the recent period in comparison with the decade 1983±1992 [1].

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Pgs9: The Cost-Effectiveness of High Dose Oral Versus Intravenous Proton Pump Inhibition in High-Risk Patients With Bleeding Peptic Ulcers Having Undergone Therapeutic Endoscopy

Cited by 3 publications

References 0 publications

Surgical perspectives in treatment of bleeding peptic ulcers

Surgical perspectives in treatment of bleeding peptic ulcers

Management of peptic ulcer bleeding—the roles of proton pump inhibitors and Helicobacter pylori eradication

Gastrointestinal Bleeding

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