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May 14, 2014
Intermittent PPI Therapy for Bleeding Ulcers Equal to Bolus-Continuous Infusion Care Plan

Chicago—Intermittent proton-pump inhibitor (PPI) therapy is a less costly treatment and just as effective as the current recommended care plan for managing patients who receive endoscopic treatment for bleeding ulcers: delivering an initial PPI dose followed by continuous infusion.

That’s according to Yale University researchers, who point out that the alternative also is more comfortable for patients. The study was presented recently at the 2014 Digestive Disease Week conference in Chicago.

“These findings are significant because intermittent PPI therapy requires fewer resources and costs less than the current standard practice,” said lead researcher Hamita Sachar, MD, a 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.”

After endoscopy, which allows visualization of the ulcer bleeding and sometimes is used for treatment, PPIs are administered to reduce stomach acid production and to promote the formation and stability of blood clots, according to the presentation.

To compare effectiveness of the two PPI treatments, researchers reviewed 13 trials involving 1,691 patients who received successful endoscopic therapy for management of high-risk bleeding ulcers. 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, according to the results.

The presentation points out that, 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, which requires infusion equipment, significant nursing and pharmacy involvement and movement restriction for patients 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 significantly reduces the need for pharmacy and nursing oversight, according to the study.

“Intermittent PPI therapy is as effective as the current standard regimen of bolus PPI followed by continuous infusion in patients with ulcer bleeding who receive endoscopic therapy for high-risk endoscopic findings," the researchers conclude. “The estimates of treatment effect were consistent across all clinical outcomes and difference subgroups. Given its lower resource utilization and cost, intermittent PPI should be the regimen of choice in this patient population. Current guidelines should be revised to recommend intermittent PPI therapy in place of bolus-continuous PPI infusion.”

Sachar added, “Not only will adoption of intermittent therapy as the treatment of choice result in lower costs, it will also improve our patients' experience. Patients will no longer be restricted in their movement for the three days it takes to deliver the PPI infusion.”





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