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<p>Utilization of proton pump inhibitors (PPIs) in patients with overt gastrointestinal bleeding (GIB) is poorly characterized and its impact on clinical outcomes remains unclear. This study determined PPIs utilization in patients with GIB and its impact on short- and long-term mortality and rebleeding. A prospective cohort of patients admitted with GIB from January 2013 to August 2023 at a tertiary referral center was examined. Appropriate use of PPIs was based on AGA guidelines. 846 patients admitted with GIB were followed up until death or August 2023; 462 had upper GIB including 243 from acid-related lesions. Overutilization rate of PPIs was 51% upon admission and 27% upon discharge. The underutilization rate was 25% upon discharge. Compared to PPI non-users, PPI users had less endoscopic stigmata of recent hemorrhage (SRH) and decreased need for endoscopic therapy. However, they had similar 1-month and end of follow-up mortality and rebleeding. Independent predictors of 1-month and end of follow up rebleeding were SRH [OR 2.03 (1.16–3.54), and 1.78 (1.21–2.64)], and severe bleeding. Being admitted on anticoagulants was predictive of 1-month rebleeding [OR 2.3 (1.2, 4.4)], while being discharged on antiplatelets was protective against long term rebleeding [OR 0.45 (0.28–0.72)]. Blood transfusion and Charlson Comorbidity Index were predictors of 1-month and long-term mortality. Being discharged on anticoagulants predicted long-term mortality [OR 2.51(1.45–4.36)]. There is significant over- and underutilization of PPIs in patients with GIB without a significant effect on outcomes. PPI stewardship would likely reduce healthcare costs and minimize side effects.</p>

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Proton pump inhibitors have no effect on short or long term rebleeding or mortality in patients with overt gastrointestinal bleeding

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Jamil Mrad,
  • Ali Elhadi Zreik,
  • Chantal Rizk,
  • Reem Mansour,
  • Hani Tamim,
  • Walaa G. El Sheikh,
  • Ala’ I. Sharara,
  • Fadi H. Mourad,
  • Fady Daniel,
  • Assaad Soweid,
  • Yasser H. Shaib,
  • Noelle El Asmar,
  • Don C. Rockey,
  • Kassem A. Barada

摘要

Utilization of proton pump inhibitors (PPIs) in patients with overt gastrointestinal bleeding (GIB) is poorly characterized and its impact on clinical outcomes remains unclear. This study determined PPIs utilization in patients with GIB and its impact on short- and long-term mortality and rebleeding. A prospective cohort of patients admitted with GIB from January 2013 to August 2023 at a tertiary referral center was examined. Appropriate use of PPIs was based on AGA guidelines. 846 patients admitted with GIB were followed up until death or August 2023; 462 had upper GIB including 243 from acid-related lesions. Overutilization rate of PPIs was 51% upon admission and 27% upon discharge. The underutilization rate was 25% upon discharge. Compared to PPI non-users, PPI users had less endoscopic stigmata of recent hemorrhage (SRH) and decreased need for endoscopic therapy. However, they had similar 1-month and end of follow-up mortality and rebleeding. Independent predictors of 1-month and end of follow up rebleeding were SRH [OR 2.03 (1.16–3.54), and 1.78 (1.21–2.64)], and severe bleeding. Being admitted on anticoagulants was predictive of 1-month rebleeding [OR 2.3 (1.2, 4.4)], while being discharged on antiplatelets was protective against long term rebleeding [OR 0.45 (0.28–0.72)]. Blood transfusion and Charlson Comorbidity Index were predictors of 1-month and long-term mortality. Being discharged on anticoagulants predicted long-term mortality [OR 2.51(1.45–4.36)]. There is significant over- and underutilization of PPIs in patients with GIB without a significant effect on outcomes. PPI stewardship would likely reduce healthcare costs and minimize side effects.