Intravenous pantoprazole versus omeprazole for rebleeding prevention in nonvariceal bleeding after endoscopy: a retrospective cohort study

Abstract

OBJECTIVE

To compare the efficacy of intravenous pantoprazole and omeprazole on the reduction of the rebleeding rate in patients with nonvariceal bleeding after endoscopy.

METHODS

We conducted a retrospective cohort study comparing the rates of recurrent bleeding after successful endoscopic therapy in the patients with intravenous pantoprazole and intravenous omeprazole. Patient medical records were included if they were admitted at Khon Kaen Hospital, Thailand between January 2013 to May 2015 with the first episode of endoscopic diagnostic nonvariceal bleeding with successful hemostasis and received either intravenous pantoprazole or omeprazole immediately for recurrent bleeding prophylaxis. The primary outcome was recurrent bleeding. The secondary outcomes included surgery, blood transfusion after esophagogastroduodenoscopy (EGD) and EGD retreatment.

RESULTS

A total of 1097 medical records of the patients with nonvariceal bleeding after endoscopy were reviewed (806 in the omeprazole group and 291 in the pantoprazole group). Rebleeding occurred in 33 patients. There was no differences between the two groups in term of rebleeding rate, surgery and esophagogastroduodenoscope retreatment (adjusted odds ratio (AOR), 1.56; 95% confidence interval (CI), 0.67 to 3.61; AOR, 1.26; 95% CI, 0.36 to 4.35; AOR, 1.49; 95% CI, 0.58 to 3.81, respectively). However, we founded high-risk gastroscopic findings were the only factor associated with the higher rate of rebleeding after successful endoscopic hemostasis, surgery and EGD retreatment (AOR, 5.55; 95% CI, 2.07 to 14.93; AOR, 9.49; 95% CI, 1.79 to 50.29; AOR, 3.65; 95% CI, 1.32 to 10.08, respectively).

CONCLUSION

In patients with nonvariceal bleeding after endoscopy, using intravenous pantoprazole did not decrease the rate of rebleeding after EGD treatment than using omeprazole.