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
ESOMEPRAZOLE 40 MG INTRAVENOUSLY (I.V.) RAISES INTRAGASTRIC pH TO > 4 MORE RAPIDLY THAN PANTOPRAZOLE 40 MG I.V.
Kerstin Rohss, et al. Am J Gastro 2004:99 Suppl; A59.
Evidence-based info : A retrospective evaluation of prospectively collected data
Type of Study : Marketing study AstraZeneca
Sample size : n = 25
It is generally accepted that to prevent rebleeding after an upper GI bleed a pH of > 6 is required (continuously) – the first 4 hrs are the most crucial.
This study uses an arbitrary, “made up” pH control value termed “stable pH control” (i.e. pH > 4 for 30 minutes). This “stable pH control” has not been validated as meaning anything in clinical practice.
Also the patients were fed standardized meals throughout.
Primary finding : If you feed patients while you infuse intravenous PPI you can provide “stable pH control”.
Score of Study (TOES): = 75 out of 100
Is it consistent with what we already know? – Yes
I.V. PPIs work better if you feed the patient (or infuse pentagastrin).
How should this effect your practice?
- Unless you plan to feed the patient a standardized meal while you are infusing the i.v. PPI, then I would ignore the findings of this study because they lack external validity to your clinical situation. In addition, there is no proven value to obtaining “stable pH control”.
- Note: This is a common trick for studies of i.v. PPIs. In order to “turn on” proton pumps the patients are either fed “standardized meals” or they receive infusions of pentagastrin.