PTH-028 Use of PPIS in acute non-variceal upper GI bleeds in a university teaching hospital

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Abstract

Introduction

Acute non-variceal upper GI bleeds are a common presentation to UK hospitals. NICE guidelines state patients should not receive treatment with proton pump inhibitors (PPI) prior to endoscopy1, as the 2010 Cochrane review2 showed no reduction in mortality, re-bleeding or need for surgery. The review did however show a reduction in the requirement for endoscopic therapy.2

Methods

We carried out a retrospective review of 763 patients who received an upper GI endoscopy for non-variceal bleeding between September 2010 and September 2013 at Cardiff and Vale University health board. Patients were divided into 2 groups depending on the receipt of PPI’s pre-endoscopy. We then compared outcomes for both groups including mortality, need for surgery, re-bleeding and need for intervention at endoscopy.

Results

Our data showed 77% of patients were treated with a PPI pre-endoscopy despite NICE guidelines. There was not a significant difference in death rates (9% vs 14%, p=0.91), need for surgery (3% vs 2% p=0.28) or re-bleeding (6% vs 8% p=0.37) in these patients. Our data does show a significant reduction in the need for endoscopic intervention (p=0.014) in patients pre-treated with a PPI.

Conclusion

Use of PPI pre-endoscopy is not detrimental to patient outcomes and our data supports the existing evidence base suggesting a reduction in the need for endoscopic intervention2. Further study is needed to evaluate the cost effectiveness of PPI use pre-endoscopy.

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