Prophylactic Proton Pump Inhibitors in Upper Gastrointestinal Bleeding: Impact and Underprescription in a French Multicentric Cohort

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发表日期：

2024年10月12日

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Weam El Hajj,
Stéphane Nahon,
Eddy Fares,
Vincent Quentin,
Denis Grasset,
Jean-Pierre Arpurt,
Florence Skinazi,
René-Louis Vitte,
Laurent Costes,
André-Jean Remy,
Christophe Locher,
Gilles Macaigne,
Christophe Agnello,
Frédérique Alabert,
Morgane Amil,
Yves Arondel,
Ramuntcho Arotcarena,
Jean-Pierre Arpurt,
Karim Aziz,
Mathieu Baconnier,
Sandrine Barge,
Georges Barjonet,
Julien Baudon,
Lucile Bauguion,
Marie Bellecoste,
Serge Bellon,
Alban Benezech,
Aliou Berete,
Chantal Berger,
Jean-Guy Bertolino,
Karine Bideau,
Gaëlle Billet,
Massimo Bocci,
Isabelle Borel,
Madina Boualit,
Dominique Boutroux,
Slim Bramli,
Pascale Catala,
Claire Charpignon,
Jonathan Chelly,
Marie Colin,
Rémi Combes,
Laurent Costes,
Baya Coulibaly,
David Cuen,
Gaëlle D’hautefeuille,
Hortense Davy,
Mercedes DE Lustrac,
Stéphanie DE Montigny-Lenhardt,
Jean-Bernard Delobel,
Anca-Stela Dobrin,
Florent Ehrhard,
Khaldoun Elriz,
Anouk Esch,
Roger Faroux,
Mathilde Fron,
Cécile Garceau,
Armand Garioud,
Edmond Geagea,
Denis Grasset,
Loïc Guerbau,
Jessica Haque,
Florence Harnois,
Frédéric Heluwaert,
Denis Heresbach,
Sofia Herrmann,
Clémence Horaist,
Mehdi Kaassis,
Jean Kerneis,
Carelle Koudougou,
Ludovic Lagin,
Margot Laly,
You-Heng Lam,
Rachida Leblanc-Boubchir,
Antonia Legruyer,
Delphine Lemee,
Christophe Locher,
Dominique Louvel,
Henri Lubret,
Gilles Macaigne,
Vincent Mace,
Emmanuel Maillard,
Magdalena Meszaros,
Mohammed Redha Moussaoui,
Stéphane Nahon,
Amélie Nobecourt,
Etienne Pateu,
Thierry Paupard,
Arnaud Pauwels,
Agnès Pelaquier,
Olivier Pennec,
Mathilde Petiet,
Fabien Pinard,
Vanessa Polin,
Marc Prieto,
Gilles Quartier,
Vincent Quentin,
André-Jean Remy,
Marie-Pierre Ripault,
Isabelle Rosa,
Thierry Salvati,
Matthieu Schnee,
Leila Senouci,
Florence Skinazi,
Nathalie Talbodec,
Quentin Thiebault,
Ivan Touze,
Marie Trompette,
Laurent Tsakiris,
Hélène Vandamme,
Charlotte Vanveuren,
Juliette Verlynde,
Joseph Vickola,
René-Louis Vitte,
Faustine Wartel,
Oana Zaharia,
David Zanditenas,
Patrick Zavadil

摘要

Background

Appropriate prescription of Proton pump inhibitors (PPIs) remains an important concern amid the rising overuse. A gap exists in the literature regarding the benefit of PPI prophylaxis and the consequences of underprescription in patients at risk for upper gastrointestinal bleeding (UGIB).

Aims

This study aims to describe the characteristics of hemorrhage in relation to PPI use in patients experiencing UGIB, with a focus on high-risk individuals requiring gastroprotection.

Methods

Data from a French multicentric cohort of patients experiencing UGIB were analyzed. Patients using PPI were compared to those without PPI considering bleeding etiologies and outcomes of peptic ulcer disease (PUD)-related hemorrhage. The rate of PPI use and its effect on bleeding characteristics in high-risk populations, defined based on international guidelines, were also assessed.

Results

Among 2497 included patients, 31.1% were on PPI at bleeding onset. PPI users exhibited a significantly lower rate of PUD-related bleeding in comparison with those without PPI (24.7 vs 40.8%, respectively, p < 0.0001). Similar difference was observed in high-risk populations, of whom, only 40.3% had gastroprotection with PPI before bleeding onset. PPI prophylaxis, however, did not influence the severity of bleeding in the general study population or in high-risk groups. Multivariate analysis identified age, comorbidities, and having more than two anti-thrombotic agents as predictors of severe bleeding.

Conclusions

PPI users appear to have a lower rate of bleeding ulcers compared to non-users. However, underprescription in high-risk groups raises the need for standardized care to ensure appropriate PPI use.