PRE-ENDOSCOPIC INTRAVENOUS PROTON PUMP INHIBITORS HAVE NO IMPACT ON CLINICAL OUTCOMES IN ACUTE UPPER GASTROINTESTINAL BLEEDING: A PROSPECTIVE MULTICENTER ITALIAN COHORT STUDY

Aims Incidence of hospital admission for acute upper gastrointestinal bleeding (AUGIB) has decreased by 20% during the past 10 years, due to the changing epidemiology. The use of pre-endoscopic intravenous proton pump inhibitors (PPIs), currently recommended, is debated. Aim to verify if the use of pre-endoscopic PPIs improves the death and outcomes rate in these patients

Methods Data on consecutive patients admitted for AUGIB were collected from January 2014 to December 2015, in 50 participating centers in Italy. Bleeding-related death was defined as any event occurring within 30 days from admission for non-variceal bleeders (NVB) and within 42 days for variceal bleeds (VB). Clinical outcomes measured were:1. hospital stay (mean duration of in hospital admission); 2. therapeutic endoscopy rate (any hemostatic procedure performed during the first endoscopy); 3. rebleeding rate (occurred after a successful hemostatic endoscopic treatment) 4. Surgery rate (any surgical procedure occurred after endoscopy).

Results 3.324 patients were included [560 VB (16.9%) and 2.764 (83.1%) NVB]. Overall, 68.7% patients received PPIs. Comorbidities were present in 79.8% of the patients with NVB and 96.9% in VB.Among the VB, the use of PPIs did not affect mortality (p < 0.21), nor the rebleeding rate (p=.92).Among the NVB, 1910 received a PPI, while 854 did not. The use of PPIs did not affect mortality (YPPI 6.0% vs. NPPI 5.1%, p< 0.36) or the measured outcomes (rebleeding rate p< 0.97; surgery rate p < 0.24; therapeutic endoscopy rate p < 0.04). Moreover, in a subgroup of patients [1456 (43.8%)] identified after endoscopy as ulcer bleeders, the administration of PPIs before endoscopy did not affect any clinical outcome (p=ns for all).

Conclusions A large proportion of patients admitted for AUGIB received PPIs before endoscopy. In our cohort of patients the administration of PPIs before endoscopy did not improve the death rate nor the other outcomes considered.