Intravenous proton pump inhibitors vs oral potassium competitive acid blockers before endoscopic treatment of bleeding peptic ulcers.

Abstract

Background: The use of proton pump inhibitors (PPIs) with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.

Aim: To compare intravenous PPIs and oral potassium competitive acid blockers (PCABs) administered prior to endoscopic treatment of bleeding peptic ulcers.

Methods: This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding (treated August 2023 to February 2024). Prior to emergency endoscopy, patients received either intravenous PPI (pantoprazole 80 mg bolus) or oral PCAB (tegoprazan 50 mg single-dose). Severity of bleeding was assessed using the Glasgow-Blatchford, Rockall, and AIMS65 scoring systems. Patients with severe comorbidities were excluded. Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding. Multivariate logistic regression was performed to adjust for potential confounding factors.

Results: Total of the 105 patients, 61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy. To minimize selection bias, bleeding severity was assessed using the Glasgow-Blatchford, Rockall and AIMS65 scores, with no statistically significant differences observed between the two groups. During emergency endoscopy performed within 48 hours, ulcer bed status was classified according to the Forrest classification. The proportion of lesions graded IIa or higher was significantly lower in the PCAB group (P < 0.001), as was the frequency of therapeutic endoscopy intervention (odds ratio = 0.272, 95% confidence interval: 0.111-0.665, P = 0.004). The frequency of re-bleeding events was statistically significantly higher in the PPI group (odds ratio = 0.141, 95% confidence interval: 0.024-0.844, P = 0.032).

Conclusion: Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.