Efficacy Of Different Doses Of Proton Pump Inhibitors In The Prevention Of Rebleeding After Endoscopic Hemostasis For Peptic Ulcer

Background and objective:Peptic ulcer bleeding(PUB)is a common and life-threatening disease in gastroenterology,and its annual morbidity and mortality are still high.China is an area with a high incidence of peptic ulcers,previous studies shown that the detection rate of high-risk ulcers has increased compared with the 1990 s.Endoscopic hemostasis is an effective treatment for bleeding ulcer.The use of proton pump inhibitor(PPI)after endoscopic hemostasis can effectively prevent rebleeding.However,there is still controversy as to whether there is a difference in efficacy between high-dose PPI and standard-dose PPI.Propensity score matching(PSM)is a statistical method commonly used to deal with observational studies.In observational research,due to the existence of data bias and confounding variables,the results of observational research are prone to systematic bias.Using PSM can control confounding variables to make the research results more reliable.This study intends to use PSM to control confounding variables,and then perform a stratified analysis of peptic ulcer after endoscopic hemostasis according to Glasgow-Blatchford score(GBS),finally compare the efficacy of high-dose and standard-dose intravenous proton pump inhibitors in high-risk and low-risk patients.Methods:We retrospectively reviewed the data of 346 patients with bleeding ulcers and high-risk stigmata who underwent endoscopic hemostasis between March 2014 and September 2018 in our center and were divided into an HD-IVPs group and an SD-IVPs group.Propensity score-matching(PSM)analysis was performed to control for selection bias and other potential confounders.Recurrent bleeding rates were calculated according to the GBS.Results:Overall,346 patients meeting the inclusion criteria were enrolled,with 89 patients in the SD-IVPs group and 89 patients in the HD-IVPs group after matching with all baseline characteristics balanced(p > 0.05).GBS = 8 was the best cutoff for identifying high-risk rebleeding patients(GBS ≥ 8)with a significant difference(p =0.015)in recurrence rate between the SD-IVPs(17/61,27.9%)and HD-IVPs(7/65,10.8%)groups and low-risk rebleeding patients(GBS < 8)with no difference(p = 1)in recurrence rate between the SD-IVPs(2/28,7.1%)and HD-IVPs(2/24,8.3%)groups.Conclusion:The best cutoff for identifying high-risk and low-risk rebleeding patients with bleeding ulcers and high-risk stigmata after endoscopic hemostasis was GBS=8.Although HD-IVPs is more effective than SD-IVPs in high-risk patients,they are equally effective in low-risk patients.