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

Author:

Hajj Weam El1,Nahon Stéphane1,Fares Eddy1,Quentin Vincent2,Grasset Denis3,Arpurt Jean-Pierre4,Skinazi Florence5,Vitte René-Louis6,Costes Laurent7,Remy André-Jean8,Locher Christophe9,Macaigne Gilles1

Affiliation:

1. Groupe Hosptalier Intercommunal Le Raincy - Montfermeil

2. Centre hospitalier Yves-le Foll

3. Centre Hospitalier Bretagne-Atlantique

4. Centre Hospitalier d'Avignon

5. Hôpital Delafontaine

6. Centre hospitalier intercommunal de Poissy, POISSY

7. Centre Hospitalier Intercommunal de Créteil

8. Centre Hospitalier de Perpignan

9. Grand Hôpital de l'Est Francilien

Abstract

Abstract

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 treatment and the consequences of underprescription in patients at risk for upper gastrointestinal bleeding (UGIB). Aims: This study aims to investigate the impact of PPI prophylaxis on the characteristics of hemorrhage 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 prescription 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 41% had gastroprotection 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.

Publisher

Springer Science and Business Media LLC

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