Less Costly, Patient-Friendly Therapy for Bleeding Ulcers Just as Effective as Standard of Care

The current standard of care for managing patients who receive endoscopic treatment for bleeding ulcers-an initial dose of a proton pump inhibitor (PPI) followed by continuous PPI infusion-should be replaced by intermittent PPI therapy. A new study says this approach is an equally safe, less costly alternative that is more comfortable for patients.

“These findings are significant because intermittent PPI therapy requires fewer resources and costs less than the current standard practice,” said lead researcher Hamita Sachar, MD, senior fellow in the digestive diseases section at Yale School of Medicine.

“In my opinion, these robust data from randomized controlled trials support the idea that intermittent PPI therapy is an equivalent therapy,” she told a press briefing held before her presentation at Digestive Disease Week 2014 in Chicago.

Endoscopy, the first step in treating bleeding ulcers, allows direct visualization of the bleeding and, in some cases, treatment. PPI therapy complements endoscopic treatment by reducing stomach acid production and promotes the formation and stability of blood clots.

In comparing the effectiveness of the 2 PPI treatments, Dr Sachar and colleagues performed a systematic review and meta-analysis of 13 trials involving nearly 1700 patients who received successful endoscopic therapy for management of high‐risk findings in bleeding ulcers. “We found that using intermittent PPI therapy resulted in a similar likelihood of re‐bleeding, death, need for urgent interventions such as surgery, more blood transfusions, or an increased length of hospital stay,” she said.

Dr Sachar presented data from the study (Abstract 331, “Intermittent PPI Therapy Is Non‐Inferior to Guideline‐Recommended Bolus‐Continuous Infusion PPI Therapy After Endoscopic Hemostasis in Patients With Ulcer Bleeding: A Systematic Review and Meta‐Analysis”) on Sunday, May 4, 2014.

Under the current guidelines, patients receive an initial dose of PPI and then are given a maintenance dose through a continuous IV line for 72 hours. This approach makes use of infusion equipment, which requires significant nursing and pharmacy attention and restricts patient movement. With intermittent PPI therapy, patients are given a dose of PPI, either orally or through an IV line, at set intervals and are not connected to infusion equipment, which markedly reduces the need for pharmacy and nursing oversight.

“Not only will adoption of intermittent therapy as the treatment of choice result in lower costs, it will also improve our patients’ experience,” said Dr Sachar. “Patients will no longer be restricted in their movement for the 3 days it takes to deliver the PPI infusion.”

She added: “The findings point to the need to revise the current standard of care. We recommend intermittent PPI therapy, which is an equally safe, less costly, more comfortable alternative for patients.”

Current guidelines are based on the benefits of PPI infusion compared with no therapy after endoscopy. Intermittent PPI therapy has been compared with placebo and shown to be beneficial, she said. “This meta-analysis essentially shows that outcomes were not poorer with intermittent PPI therapy,” Dr Sachar said.