BACKGROUND: In the latest guidelines by Drs. Laine and Jensen regarding proton pump inhibitor (PPI) therapy for high risk bleeding ulcers entitled, Management of Patients with Ulcer Bleeding, it is recommended that an intravenous bolus dose of a PPI followed by continuous PPI infusion after endoscopic therapy in patients with high-risk bleeding ulcers be given. This meta-analysis would like to compare if intermittent Pantoprazole therapy would be non-inferior to continuous Pantoprazole therapy. This could be practice-changing as this would not only decrease the dose but also decrease hospital cost.
OBJECTIVE: To assess non-inferiority of intermittent Pantoprazole therapy from the currently recommended bolus plus continuous Pantoprazole therapy.
METHODS: Search was done using PubMed, UpToDate and MedLine search engines. Seven abstracts of randomized controlled trials (RCTs) of patients with endoscopically treated high-risk bleeding ulcers (active bleeding, non-bleeding visible vessels, and adherent clots) comparing intermittent doses of Pantoprazole and the currently recommended regimen (80-mg intravenous bolus dose of Pantoprazole followed by an infusion of 8 mg/h for 72 hours) were initially selected. However among these 7 abstracts, only three studies showed comparable methodology and Pantoprazole dose regimen. Accordingly, the meta-analysis was done using these three studies.
RESULTS: The use of intermittent Pantoprazole was non-inferior compared to continuous Pantoprazole treatment in patients having high-risk bleeding ulcers.
CONCLUSION: Considering that intermittent Pantoprazole will tremendously decrease the cost and utilization of medicine, while being able to provide the necessary medication without compromise on the patient's safety, it is highly recommended that current guidelines be reviewed and consider the possibility of including intermittent Pantoprazole as mainstay and comparable to continuous Pantoprazole infusion.