Scandinavian Journal of Gastroenterology. 2014; Early Online, 1–10 ORIGINAL ARTICLE Outcomes of peptic ulcer bleeding following treatment with proton pump inhibitors in routine clinical practice: 935 patients with high- or low-risk stigmata ANGEL LANAS 1,2 , PATRICIA CARRERA-LASFUENTES 2 , LUIS A. GARCÍA-RODRÍGUEZ 3 , SANTIAGO GARCÍA 4 , MARÍA TERESA ARROYO-VILLARINO 1,2 , JULIO PONCE 2,5 , LUIS BUJANDA 2,6 , JOSÉ L. CALLEJA 7 , MÓNICA POLO-TOMAS 2 , XAVIER CALVET 2,8 , FAUST FEU 2,9 & ANGELES PEREZ-AISA 1 1 Servicio de Aparato Digestivo, Hospital Clínico, Universidad de Zaragoza, IIS Aragón, Zaragoza, Spain, 2 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain, 3 Centro Español de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain, 4 Hospital Universitario Miguel Servet, Zaragoza, Spain, 5 Hospital La Fe, Valencia, Spain, 6 Hospital Donostia-Instituto Biodonostia, CIBERehd, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain, 7 Servicio de Aparato Digestivo, Hospital Puerta de Hierro, Madrid, Spain, 8 Servicio de Aparato Digestivo, Departament de Medicina, Universitat Autònoma de Barcelona, Parc Taulí, Barcelona, Spain, 9 Servicio de Aparato Digestivo, Hospital Clinic, Barcelona, Spain, and 10 Servicio de Aparato Digestivo, Hospital Costa del Sol, Málaga, Spain Abstract Objective. To assess rates of further bleeding, surgery and mortality in patients hospitalized owing to peptic ulcer bleeding. Materials and methods. Consecutive patients hospitalized for peptic ulcer bleeding and treated with a proton pump inhibitor (PPI) (esomeprazole or pantoprazole) were identified retrospectively in 12 centers in Spain. Patients were included if they had high-risk stigmata (Forrest class Ia–IIb, underwent therapeutic endoscopy and received intravenous PPI ‡120 mg/day for ‡24 h) or low-risk stigmata (Forrest class IIc–III, underwent no therapeutic endoscopy and received intravenous or oral PPI [any dose]). Results. Of 935 identified patients, 58.3% had high-risk stigmata and 41.7% had low-risk stigmata. After endoscopy, 88.3% of high-risk patients and 22.1% of low-risk patients received intravenous PPI therapy at doses of at least 160 mg/day. Further bleeding within 72 h occurred in 9.4% and 2.1% of high- and low-risk patients, respectively (p < 0.001). Surgery to stop bleeding was required within 30 days in 3.5% and 0.8% of high- and low-risk patients, respectively (p = 0.007). Mortality at 30 days was similar in both groups (3.3% in high-risk and 2.3% in low-risk patients). Conclusion. Among patients hospitalized owing to peptic ulcer bleeding and treated with PPIs, patients with high-risk stigmata have a higher risk of further bleeding and surgery, but not of death, than those with low-risk stigmata. Key Words: peptic ulcer hemorrhage, pharmacoepidemiology, proton pump inhibitors, retrospective study Introduction Acute peptic ulcer bleeding is considered to be a medical emergency and is a common cause of hospitalization worldwide. It is associated with considerable patient morbidity and significant healthcare costs [1,2]. The annual incidence of peptic ulcer bleeding has been reported to be between 20 and 60 per 100,000 adults [3]. International consensus guidelines recommend that patients with high-risk stigmata who have under- gone successful endoscopic therapy following a peptic Correspondence: Angel Lanas, Hospital Clinico Universitario "Lozano Blesa", Avenida San Juan Bosco, 15 50009, Zaragoza, Spain. E-mail: angel.lanas@gmail.com (Received 13 March 2014; revised 28 July 2014; accepted 28 July 2014) ISSN 0036-5521 print/ISSN 1502-7708 online Ó 2014 Informa Healthcare DOI: 10.3109/00365521.2014.950694 Scand J Gastroenterol Downloaded from informahealthcare.com by 188.78.214.25 on 08/22/14 For personal use only.