Description of Prescribing Practices in Patients with Upper Gastrointestinal Bleeding Receiving Intravenous Proton-Pump Inhibitors: A Multicentre EvaluationReport as inadecuate




Description of Prescribing Practices in Patients with Upper Gastrointestinal Bleeding Receiving Intravenous Proton-Pump Inhibitors: A Multicentre Evaluation - Download this document for free, or read online. Document in PDF available to download.

Canadian Journal of Gastroenterology - Volume 18 2004, Issue 9, Pages 567-571

Original Article

Division of Gastroenterology, Department of Medicine, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada

Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada

Richmond General Hospital, Richmond, Canada

Lion’s Gate Hospital, North Vancouver, Canada

Royal Columbian Hospital, New Westminster, Canada

Vancouver General Hospital, Vancouver, Canada

Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada

Received 5 February 2004; Accepted 16 June 2004

Copyright © 2004 Hindawi Publishing Corporation. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License CC BY-NC http:-creativecommons.org-licenses-by-nc-4.0-, which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.

Abstract

BACKGROUND: Intravenous forms of proton pump inhibitors IV PPI are routinely used for patients with acute upper gastrointestinal bleeding, but a significant concern for their inappropriate use has been suggested.

PATIENTS and METHODS: All consecutive patients who received IV PPI pantoprazole over 20 months in six Canadian hospitals were reviewed. Prescribing practices, endoscopic findings and outcomes were recorded.

RESULTS: A total of 854 patients received IV PPI. Over 90% of patients were given IV PPI for treatment of known or suspected active upper gastrointestinal bleeding. Most patients 69% underwent upper endoscopy, and 58% of these patients had peptic ulcer disease PUD. The majority of patients who had endoscopy 57% had IV PPI administered in advance of the procedure. Of the 334 patients who had IV PPI given in advance, 46 13.8% were found to have high risk bleeding PUD stigmata at endoscopy. The remaining 288 patients 86.2% with advance IV PPI had low-risk PUD lesions or non-PUD lesions; IV PPI was continued after endoscopy in 164 56.9% of these patients.

CONCLUSIONS: IV PPI is often used before endoscopy in suspected upper gastrointestinal bleed and maintained, regardless of endoscopic findings, after the endoscopy in many Canadian centres. Further study is required to support these clinical practices.





Author: Robert Enns, Christopher N Andrews, Martin Fishman, Michael Hahn, Kenneth Atkinson, Peter Kwan, and Adrian Levy

Source: https://www.hindawi.com/



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