Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Original Article

Volume 11, Number 3, June 2018, pages 200-206


Once Versus Twice-Daily Oral Proton Pump Inhibitor Therapy for Prevention of Peptic Ulcer Rebleeding: A Propensity Score-Matched Analysis

Figure

Figure 1.
Figure 1. Flow diagram of included patients.

Tables

Table 1. Baseline Patient Characteristics in Patients Discharged on Once Versus Twice-Daily Oral PPI Therapy
 
All patientsPropensity score-matched patients
Once-daily (n = 49)Twice-daily (n = 184)P valueOnce-daily (n = 49)Twice-daily (n = 48)P value
Values between parentheses are percentages unless otherwise specified. Values with a plus/minus sign (±) represent means ± standard deviation. BMI: body mass index; ASA: American Society of Anesthesiologists; NSAID: non-steroidal anti-inflammatory drug; DOAC: direct oral anticoagulant.
Age, mean ± SD61.6 ± 1461.1 ± 15.20.80061.6 ± 1461 ± 14.30.821
Male, n (%)33 (67.4)90 (48.9)0.02233 (67.4)24 (50)0.083
Caucasian44 (90)160 (87)0.59344 (90)42 (88)0.721
BMI (kg/m2), median (IQR)26.5 (23.1 - 31.4)27.1 (23.2 - 32.5)0.67326.5 (23.1 - 31.4)25.8 (22.3 - 30.3)0.449
Smokers, n (%)12 (24.5)61 (33.1)0.33512 (24.5)16 (33.3)0.626
Alcohol use18 (36.7)67 (36.4)0.96718 (36.7)16 (33.3)0.726
ASA score (n = 218)0.0110.084
  12 (4.2)0 (0)2 (4.2)0 (0)
  28 (16.7)53 (31.2)8 (16.7)14 (29.8)
  329 (60.4)96 (56.5)29 (60.4)30 (63.8)
  49 (18.8)21 (12.4)9 (18.8)3 (6.4)
Hemodynamic shock7 (14.3)41 (22.3)0.2197 (14.3)11 (22.9)0.274
Presenting symptoms
  Melena32 (65.3)111 (60.3)0.52532 (65.3)20 (41.7)0.020
  Hematemesis10 (20.4)36 (19.6)0.89510 (20.4)11 (22.9)0.764
  Hematochezia4 (8.2)26 (14.1)0.2684 (8.2)2 (4.1)0.414
  Syncope1 (2)10 (5.4)0.3201 (2)4 (8.3)0.161
H. pylori status0.2830.526
  Negative34 (69.4)140 (76.1)34 (69.4)39 (81.2)
  Positive4 (8.2)30 (16.3)4 (8.2)7 (14.6)
  Missing11 (22.5)14 (7.6)11 (22.5)2 (4.2)
Medications
  Aspirin23 (46.9)95 (51.6)0.55923 (46.9)27 (56.3)0.359
  Non- aspirin NSAIDs16 (32.7)58 (31.5)0.88016 (32.7)16 (33.3)0.943
  Anti-platelet7 (14.3)20 (10.9)0.5077 (14.3)6 (12.5)0.796
  DOAC2 (4.1)10 (5.4)0.7032 (4.1)2 (4.2)0.983
  Warfarin7 (14.3)16 (8.7)0.2447 (14.3)4 (8.3)0.355
  Heparin2 (4.1)8 (4.4)0.9352 (4.1)0 (0)0.157
  Steroids1 (2)16 (8.7)0.1111 (2)6 (12.5)0.047

 

Table 2. Details of Proton Pump Inhibitor Therapy Types, Frequency, and Dosing in the Two Groups
 
All patientsPropensity score matched patients
Once-daily (n = 49)Twice-daily (n = 184)Once-daily (n = 49)Twice-daily (n = 48)
Omeprazole 40 mg21 (42.8%)20 (11%)21 (43%)4 (8%)
Pantoprazole 40 mg25 (51%)160 (87%)25 (51%)41 (85%)
Esomeprazole 40 mg3 (6%)4 (2%)3 (6%)3 (6%)

 

Table 3. Initial Endoscopic Findings in Patients Discharged on Once Versus Twice-Daily Therapy
 
All patientsPropensity score-matched patients
Once-daily (n = 49)Twice-daily (n = 184)P valueOnce-daily (n = 49)Twice-daily (n = 48)P value
Rockall score, median (IQR)4 (3 - 5)4 (3 - 6)0.2594 (3 - 5)4 (3 - 5)0.858
Forrest class0.0060.201
  1a09 (4.9)01 (2.1)
  1b4 (8.2)27 (14.7)4 (8.2)5 (10.4)
  2a4 (8.2)24 (13)4 (8.2)4 (8.3)
  2b8 (16.3)6 (3.2)8 (16.3)1 (2.1)
  2c2 (4.1)13 (7.1)2 (4.1)4 (8.3)
  331 (63.3)105 (57.1)31 (63.3)33 (65.9)
Number of endoscopic treatments0.2820.473
  030 (61.2)114 (62)30 (61.2)33 (68.8)
  18 (16.3)24 (13)8 (16.3)4 (8.3)
  211 (22.5)34 (18.5)11 (22.5)10 (20.8)
  30 (0)12 (6.5)0 (0)1 (1)
Ulcer size, mm0.3730.662
  Mean ± SD10.7 ± 7.811.3 ± 7.610.7 ± 7.810.6 ± 7.7
  Range2-302-402-302-40
Ulcer location, n (%)
  Gastric32 (65.3)112 (60.9)0.57032 (65.3)31 (64.6)0.941
  Duodenal16 (32.7)83 (45.1)0.11716 (32.7)19 (39.6)0.477
Number of ulcers0.7150.126
  Single ulcer27 (55.1)96 (52.2)27 (55.1)19 (39.6)
  Multiple ulcers22 (44.9)88 (47.8)22 (44.9)29 (60.4)

 

Table 4. Primary and Secondary Outcomes in Patients Discharged on Once Versus Twice-Daily Therapy
 
All patientsPropensity score-matched patients
Once-daily (n = 49)Twice-daily (n = 184)P valueOnce-daily (n = 49)Twice-daily (n = 48)P value
Recurrent bleeding
  Within 30 days7 (14.3)11 (6)0.0537 (14.3)2 (4.2)0.159
All-cause mortality
  Within 30 days0 (0)4 (2.2)0.5820 (0)2 (4.2)0.242
Blood transfusion requirement
  For recurrent bleed5047271
  Mean (SD)1.5 (2.1)1.3 (1.6)0.5843.9 (4.5)0.5 (0.7)0.445
Additional hospital days for recurrent bleed
  Total4768476
  Mean (SD)6.7 (4.4)6.2 (5.2)0.6141 (2)2 (4.2)0.125
Required IR embolization within 30 days2 (28.6)2 (18.2)12 (4.1)0 (0)0.495
Required surgery within 30 days1 (14.3)0 (0)0.3891 (2.1)0 (0)0.32