scholarly journals Cost-Effectiveness of Intravenous Proton Pump Inhibitors in High-Risk Bleeders

2004 ◽  
Vol 18 (12) ◽  
pp. 749-750
Author(s):  
Sander Veldhuyzen van Zanten
Keyword(s):  
Cost Effectiveness ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Gastric Ulcers ◽  
Recurrent Bleeding ◽  
Gi Bleeding ◽  
H2 Blockers ◽  
Rapid Healing ◽  
Upper Gastrointestinal

There is unequivocal evidence that proton pump inhibitors (PPIs) are currently the most effective acid suppressive agents available. Intravenous (IV) formulations have been developed, although only IV pantoprazole is available in Canada. In patients presenting with serious upper gastrointestinal (GI) bleeding due to duodenal or gastric ulcers, it has always been believed that IV administration of acid-lowering agents would improve clinical outcomes. The reason behind this thinking is twofold. First, there is in vitro evidence that formed clots are more stable at or near neutral pH (1). Second, by administering the agent intravenously, suppression of acid production is achieved much more quickly, thereby promoting more rapid healing of the ulcer and reducing the risk of persistent or recurrent bleeding. Interestingly and surprisingly, however, the data for intravenous H2-blockers have been disappointing (2). This failure to demonstrate clinical benefit has never been fully explained.

Erratum: Overutilization of Proton Pump Inhibitors: A Review of Cost-Effectiveness and Risk in PPI

2009 ◽  
Vol 104 (4) ◽  
pp. 1072-1072
Author(s):  
Joel J Heidelbaugh ◽  
Kathleen L Goldberg ◽  
John M Inadomi
Keyword(s):  
Cost Effectiveness ◽  
Proton Pump Inhibitors ◽  
Proton Pump

scholarly journals Does the rapid healing of duodenal ulcers mean longer remissions?

1998 ◽  
Vol 4 (3) ◽  
pp. 554-559
Author(s):  
W. Ahmed
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Response To Therapy ◽  
Duodenal Ulcers ◽  
H2 Blockers ◽  
Rapid Healing ◽  
Relapse Rates

A study was conducted to test the response to therapy and the relapse rates of endoscopically-confirmed duodenal ulcers. Endoscopy to check for healing was performed at 4 and 8 weeks in cases receiving H2-blockers and misoprostol and at 14 and 28 days in cases receiving a proton pump inhibitor. Endoscopy was repeated at 1, 3, 6 and 12 months to check for relapses. Healing rates were 61%-77% and 75%-85% at 4 and 8 weeks in the group receiving H2-blockers and misoprostol. Healing rates were 68% and 100% at days 14 and 28 with the proton pump inhibitor. The relapse rates within 3 months were 72%-86% and 100% respectively. This study indicates that the faster the ulcer healed, the earlier the relapse occurred

scholarly journals The use of proton pump inhibitors decreases the risk of diabetes mellitus in patients with upper gastrointestinal disease

Medicine ◽  
2016 ◽  
Vol 95 (28) ◽  
pp. e4195 ◽  
Author(s):  
Hsiu-Chen Lin ◽  
Yu-Ting Hsiao ◽  
Hsiu-Li Lin ◽  
Yow-Shieng Uang ◽  
Hui-Wen Cheng ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Gastrointestinal Disease ◽  
Upper Gastrointestinal

Are Proton Pump Inhibitors More Effective Than Histamine-2-Receptor Antagonists for Stress Ulcer Prophylaxis in Critically Ill Patients? A Systematic Review and Meta-Analysis of Cohort Studies

2021 ◽  
pp. 106002802110590
Author(s):  
Na He ◽  
Yingying Yan ◽  
Shan Su ◽  
Qinggang Ge ◽  
Suodi Zhai
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Critically Ill ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Stress Ulcer ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Gi Bleeding ◽  
Ulcer Prophylaxis

Background: Histamine-2-receptor antagonists (H2RAs) have been largely replaced by proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) despite the inconclusive evidence concerning comparative effectiveness. Objective: To compare the effectiveness of PPIs and H2RAs on SUP in real-world setting. Methods: PubMed, Embase, and the Cochrane Library were searched from inception to September 19, 2021. We included cohort studies comparing PPIs with H2RAs in critically ill adult patients and explicitly reporting the outcome of gastrointestinal (GI) bleeding or mortality. Newcastle-Ottawa Scale was used to assess potential risk of bias. We conducted a random-effects meta-analysis and only the studies with adjusted effect estimates were pooled. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the overall quality of the evidence. Results: Thirteen cohort studies (N = 145 149) were eligible and 11 of them available for full texts were of low to moderate risk of bias. Meta-analysis of adjusted effect estimates indicated that PPIs were associated with a significantly higher risk of GI bleeding, compared with H2RAs (8 studies, odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.30-3.01, low certainty). Post hoc pooling analysis also suggested that PPIs were associated with a slightly higher risk of mortality in comparison with H2RAs (7 studies, OR = 1.27, 95% CI = 1.13-1.42, low certainty). Conclusion and Relevance: The systematic review of cohort studies showed that PPIs were associated with higher risks of GI bleeding and mortality, although the certainty of evidence was low. Overall, we suggest not excluding H2RAs for SUP, while further studies are essential for elucidating the risk stratification, optimal regimen, and specific duration.

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