Study points to potential revision of treatment guidelines for bleeding ulcers

May 04, 2014

Chicago, IL (May 4, 2014) -- The current standard of care for managing patients who receive endoscopic treatment for bleeding ulcers should be replaced by an equally safe and less costly alternative that is more comfortable for patients, according to new research presented today at Digestive Disease Week® (DDW). Researchers at the Yale University School of Medicine compared the current recommended care plan -- delivering an initial dose of proton pump inhibitor (PPI) followed by continuous PPI infusion -- to a regimen using only intermittent PPI therapy, which was found to be just as effective.

"These findings are significant because intermittent PPI therapy requires fewer resources and costs less than the current standard practice," said Hamita Sachar, MD, lead researcher of the study and senior fellow in the digestive diseases section at Yale School of Medicine. "If intermittent therapy were to become the new standard, we could increase value by lowering costs while still delivering the same high-quality care to our patients."

Endoscopy is the first step in treating bleeding ulcers, as it allows doctors to directly visualize the ulcer bleeding and in some cases treat the bleeding. 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 two PPI treatments, Dr. Sachar and her colleagues reviewed 13 trials involving 1,691 patients who received successful endoscopic therapy for management of high-risk findings in bleeding ulcers. Investigators 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.

Under the current guidelines, patients receive an initial dose of PPI and then are given a maintenance dose through a continuous intravenous (IV) line for 72 hours. This approach makes use of infusion equipment, which requires significant nursing and pharmacy attention and restricts the movement of patients while receiving the medication. 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 three days it takes to deliver the PPI infusion."

Dr. Hamita Sachar will present data from the study "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," abstract 331, on Sunday, May 4, at 10:15 a.m. CT, in room S401BC of McCormick Place. For more information about featured studies, as well as a schedule of availability for featured researchers, please visit http://www.ddw.org/press.
-end-
About DDW

Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 3-6, 2014, at McCormick Place, Chicago. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. More information can be found at http://www.ddw.org.Follow us on Twitter @DDWMeeting; hashtag #DDW14. Become a fan of DDW on Facebook.

Digestive Disease Week

Related Medicine Articles from Brightsurf:

An ultrasonic projector for medicine
A chip-based technology that modulates intensive sound pressure profiles with high resolution opens up new possibilities for ultrasound therapy.

A new discovery in regenerative medicine
An international collaboration involving Monash University and Duke-NUS researchers have made an unexpected world-first stem cell discovery that may lead to new treatments for placenta complications during pregnancy.

How dinosaur research can help medicine
The intervertebral discs connect the vertebrae and give the spine its mobility.

Graduates of family medicine residencies are likely to enter and remain in family medicine
This study provides an overview of the characteristics of physicians who completed family medicine residency training from 1994 to 2017.

Nuclear medicine and COVID-19: New content from The Journal of Nuclear Medicine
In one of five new COVID-19-related articles and commentaries published in the June issue of The Journal of Nuclear Medicine, Johnese Spisso discusses how the UCLA Hospital System has dealt with the pandemic.

Moving beyond 'defensive medicine'
Study shows removing liability concerns slightly increases C-section procedures during childbirth.

NUS Medicine researchers can reprogramme cells to original state for regenerative medicine
Scientists from NUS Medicine have found a way to induce totipotency in embryonic cells that have already matured into pluripotency.

Protein injections in medicine
One day, medical compounds could be introduced into cells with the help of bacterial toxins.

Study reveals complementary medicine use remains hidden to conventional medicine providers
Research reveals that 1 in 3 complementary medicine (CM) users do not disclose their CM use to their medical providers, posing significant direct and indirect risks of adverse effects and harm due to unsafe concurrent use of CM and conventional medicine use.

Study of traditional medicine finds high use in Sub-Saharan Africa despite modern medicine
Researchers who have undertaken the first systematic review of into the use of traditional, complementary and alternative medicines (TCAM) in Sub-Saharan Africa found its use is significant and not just because of a lack of resources or access to 'conventional medicine'.

Read More: Medicine News and Medicine Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.