Abstract
Background and Aim: The lowest effective dose of proton pump inhibitors (PPI) for prevention of peptic ulcer rebleeding remains unclear. The objective of the present study was to evaluate whether lowβdose PPI has a similar efficacy to highβdose i.v. administration for maintaining intragastric pH above 6.
Methods: Sixtyβone patients with bleeding ulcers were randomized into one of three groups after endoscopic hemostasis: pantoprazole 80βmg bolus followed by 8βmg/h; 40βmg, 4βmg/h infusion; and bolus injection of 40βmg every 24βh. Intragastric pH values and rebleeding rates were measured. In addition, pharmacokinetic parameters and association with CYP2C19 polymorphisms and H. pylori infection were assessed.
Results: Mean percentage of time with intragastric pHβ>β6, and the proportion of patients with pHβ>β6 for more than 60% of the time were significantly higher in the 40βmg, 4βmg/h infusion group compared to the 40βmg bolus injection. There was no significant difference between the 80βmg, 8βmg/h and the 40βmg, 4βmg/h groups. In the H. pylori (β) group, only 40% of patients that received continuous infusion reached the target pHβ>β6 for more than 60% of the time; this was significantly lower than the H. pylori (+) group, 87.5% (Pβ=β0.026).
Conclusions: A continuous infusion, regardless of high or low dose, was more effective for acid suppression than a 40βmg bolus PPI injection in Korea. H. pylori infection was an important factor for the maintenance of an intragastric pHβ>β6.