Dosage of Proton Pump Inhibitors in Acute Gastroduodenal Ulcer Bleedings

K.O. Yaroshenko

Abstract


Treatment of gastroduodenal ulcer bleeding remains one of the important issues of modern emergency surgery. In the case of rebleeding a number of unsatisfactory outcomes increases. Indicators of general and postoperative mortality account for 15 and 60 % respectively. Almost 90 % of early recurrent bleedings occur within the next 24–48 hours or the first 5 days after the initial bleeding stops. Proton pomp inhibitors play the most important part in treatment of acid disease.
Objective: to determine the effective dose of pantoprazole to prevent early rebleedings in patients with acute ulcers hemorrhages of pyloroduodenal zone.
Material and Methods. The study has been carried out in 112 patients with acute ulcers hemorrhages of pyloroduodenal zone. Patients have been divided into two groups (56 patients in each) depending on the doze of pantoprazole prescribed within 5 days with the later transition to oral usage in therapeutic doses: I group — pantoprazole 80 mg a day with subsequent transition to 8 mg p/h; II group — pantoprazole 80 mg a day. During the third day of treatment daily intragastric pH-monitoring has been conducted to control the efficiency of the treatment. The efficient doze of pantoprazole has been considered the one that kept pH higher than 6.0 and prevented the occurrence of rebleeding (in terms of clinic endoscopic signs).
Results and Discussions. In I group of patients the treatment was more effective and figures of intragastric pH of the majority of patients have been kept at the level of significant hypoacidity and anacidity compared to the II group with the prevailing number of patients with moderate hypoacidity and hyperacidity. Rebleeding has been observed in both groups, 8 patients (14.3 %) of the I group and 14 (25 %) of the II one. In the I group early rebleeding in patients has been stopped with the help of endoscopic hemostasis. In the II group to stop rebleeding 5 patients required surgery due to inefficiency of endoscopic methods.
Conclusions. Usage of pantoprazole in the doze of 80 mg intravenously with the later transition to 80 mg p/h within the first 5 days of the after hemorrhage period allows to improve the results of treatment in patients with acute bleeding ulcer of pyloroduodenal zone and to reduce the number of early rebleedings.


Keywords


gastroduodenal ulcer bleeding; early rebleeding; pantoprazole

References


Эффективность эндоскопического гемостаза у больных с высоким операционно-анестезиологическим риском при язвенной болезни желудка и двенадцатиперстной кишки, осложненной кровотечением / В.В. Бойко, С.В. Сушков, Д.А. Нетиков [и др.] // Харківська хірургічна школа. — 2005. — № 1(15). — С. 99-101.

Гостищев В.К. Значение антисекреторной терапии в лечении острых гастродуоденальных язвенных кровотечений / В.К. Гостищев, М.А. Евсеев // РМЖ. — 2004. — Т. 12, № 24. — С. 25-28.

Гостищев В.К. Гастродуоденальные кровотечения язвенной этиологии / В.К. Гостищев, М.А. Евсеев. — М.: ГЭОТАР-Медиа, 2008. — 379 с.

Клігуненко О.М. Гостра крововтрата / О.М. Клігуненко // Лікування та діагностика. — 2002. — № 3. — С. 20-28.

-річний досвід хірургічного лікування гострих виразкових гастродуоденальних кровотеч / П.Г. Кондратенко, Е.Е. Раденко, М.В. Соколов, М.Л. Смирнов // Шпитальна хірургія. — 2005. — № 1. — С. 118-121.

Курыгин А.А. Неотложная хирургическая гастроентерология / А.А. Курыгин, Ю.М. Стойко, С.Ф. Багненко. — СПб.: Питер, 2001. — 568 с.

Фомін П.Д. Кровотечі із верхніх відділів ШКТ: причини, фактори ризику, діагностика, лікування / П.Д. Фомін, В.І. Нікішаев // Здоров’я України. — 2010. — № 5. — С. 8-10.

Профилактика ранних рецидивов кровотечения из кровоточащих гастродуоденальных язв / П.Д. Фомин, В.И. Никишаев, С.Г. Головин, И.И. Лемко // Хірургія України. — 2004. — № 1(9). — С. 12-13.

Bardou M. Meta-analysis: proton pump inhibition in high-risk patients with acute peptic ulcer bleeding / M. Bardou, Y. Toubouti, A.N. Barkun // Aliment. Pharmacol. Ther. — 2007. — № 21. — Р. 677-686.

Barkun A.N. Review article: acid suppression in non-variceal acute upper gastrointestinal bleeding / A.N. Barkun,

A.W. Cockeram // Aliment. Pharmacol. Ther. — 2000. — № 13. — Р. 1565-1584.

Leontiadis G.I. Proton pump inhibition treatment for acute peptic ulcer bleeding / G.I. Leontiadis, V.K. Sharma, C.W. Howden / Cochrane Database Syst. Rev. — 2006. —

№ 1. — CD002094.

Metz D.C. Pantoprazolee regimens that sustain intragastric pH > 6.0: an evaluation of intermittent oral and intravenous infusion dosages / D.C. Metz, F. Am, B. Hunt // Aliment. Pharmacol. Ther. — 2006. — № 23. — Р. 985-995.

William D. Chey The practice parameters Committee of American College of Gastroenterology / William D. Chey, Benjamin C.Y. Wong // American Journal of Gastroenterology. — 2007. — № 102. — Р. 59-70.




DOI: https://doi.org/10.22141/1997-2938.2.21.2013.87510

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