TOES Evaluations of Abstracts Submitted for the 69th Annual Scientific Meeting of the American College of Gastroenterology
American Journal of Gastroenterology, Vol. 99, No. 10, Suppl., 2004, ©2004 by Am. Coll. of Gastroenterology, ISSN 0002-9270/04/xx.xx, Published by Blackwell Publishing
October 29–November 3, 2004, Orlando, Florida
THE PREVALENCE OF PROTON PUMP INHIBITOR USE IN HOSPITALIZED PATIENTS
Alan R. Gingold, D.O., Am J Gastro 2004:99 Suppl; A104.
Evidence-based info : Survey - concurrent cohort.
Type of Study : Independent study
Sample size : n = 179 patients
Background : Are we prescribing pantoprazole correctly in a group of internal medicine patients in a prestigious Medical Center?
Primary finding : The primary reason for the use of the pantoprazole was prevent upper GI bleeding Oral Pantoprazole has no demonstrated efficacy for that use. 95% of the patients had no evidence-based risk factors for upper GI bleeding in the first place.
Score of Study (TOES): = 10 out of 100
Is it consistent with what we already know? – Yes
How should this affect your practice?
- Hopefully, you aren't using oral pantoprazole tablets to prevent upper GI bleeding. Please tell me that you aren't.
- Preventing upper GI bleeding is broken into two groups.
- Those that have no recent bleeding (within 6 months) and have new conditions that put them at risk. The primary example is mechanical ventilation that is > 48 hrs duration. (i.e. stress ulcer related bleeding). Generally a pH > 4 is thought to be a useful surrogate for preventing stress-related upper GI bleeding.
- Those that have recently bled. Typically, after endoscopic hemostasis there is a desire to prevent a rebleed (70% of which are thought to be acid-related digestion of clot). A pH of 6.2 or greater, as soon as possible (within the first 4 hrs), and not dropping below the pH 6.2 is desirable. NONE of the current PPIs studied (whether given i.v. or po are able to achieve this surrogate). THERE IS NO FDA APPROVED INDICATION FOR I.V. PPI for preventing rebleeding after upper GI bleed.
Note that the mean pH or the time pH > 4 is not useful in this situation.