A randomized controlled trial comparing two different dosages of infusional pantoprazole in peptic ulcer bleeding

Aim: The optimal dosage of proton pump inhibitor in bleeding peptic ulcers remains controversial. The aim was to compare the clinical effectiveness of two doses of infusional pantoprazole in peptic ulcer bleeding. Methods: Peptic ulcer patients (n = 120) with bleeding stigmata were enrolled after successful endoscopic therapy. After an initial bolus injection of 80 mg pantoprazole, patients were randomized to receive continuously infused pantoprazole at either 192 mg day^-1 or 40 mg every 6 h (i.e. 160 mg day^-1) for 3 days. Clinical outcomes between the two groups within 14 days were compared, with 14-day recurrent bleeding regarded as the primary end-point. Results: Both groups (n = 60 each) were well matched in demographic and clinical factors upon entry. Bleeding totally recurred in 11 (9.2%) patients, with six (10%) in the 192 mg day^-1 group and five (8.3%) in the 160 mg day^-1 group (relative risk of bleeding recurrence between two treatments 1.2; 95% CI 0.39, 3.72). All secondary outcomes between the two groups were similar, including the amount of blood transfusion (mean 1179 ml vs. 1203 ml, P > 0.1), hospital stay (mean 9.5 days vs. 9.9 days, P > 0.1), need for surgery (n = 1 vs. n = 0, P > 0.1), and mortality (n = 1 vs. n = 0, P > 0.1). Conclusions: Following endoscopic haemostasis, infusional pantoprazole at either 192 mg day^-1 or 40 mg every 6 h appear similar.