The drugs called proton pump inhibitors (PPIs) are rife with dangerous complications, but I’ll admit that there are times when the benefits outweigh the risks. For example, PPIs can be a life-saving treatment for bleeding ulcers. By stopping stomach acid, they help stop the bleed. But even in circumstances where PPIs could save your life, they are still not being used as effectively or economically as they should.
New research tells us that, as far as PPIs and bleeding ulcers go, most doctors might be using them incorrectly. If you or someone you love has or had a bleeding ulcer, here’s information you need…
THE WAY IT’S DONE NOW
To understand why the approach to bleeding ulcers should probably be changed, it helps to know what’s done currently. The “gold standard”—the way experts have decided is best—is for gastroenterologists to repair bleeding ulcers through endoscopic surgery. That is, they perform surgery through a tunnel-like device called an endoscope that is snaked through the patient’s throat to the stomach or small intestines. To keep the ulcer from opening up and bleeding again during the recuperation period, patients receive a large 80-milligram (mg) dose of a PPI through an intravenous (IV) line immediately after surgery. This is followed by a continuous intravenous “drip” of the PPI (eight mg per hour) for the next 72 hours—which means that the patient is laid-up in a hospital bed for three days.
Another approach, used less often, is intermittent therapy, in which the PPI drug is given at intervals (one to four times a day ) after the surgery, either as an injection or as a pill. Although continuous and intermittent PPI therapy have yet to be compared head-to-head in a scientific study, researchers from Yale University decided to compare published studies that have been done on each. They especially focused on studies that looked at “rebleeds” (when the ulcer starts bleeding again) within seven days of surgery because this is a common time for them to occur. What the researchers found was that rebleeds within seven days after surgery were 28% less likely with intermittent therapy than with continuous therapy. And intermittent therapy came out slightly better, as well, in terms of the likelihood of the patient dying or having a complication, such as a rash or infection at the IV insertion site or an allergic reaction that required medical intervention.
HOW IT SHOULD BE DONE
The biggest benefit of intermittent PPI therapy is that patients can recuperate in the comfort of their own homes instead of in hospital beds. In the grand scheme of things, this translates into major savings in drug and hospital costs (your medical insurance and medical insurance bills). It gets patients away from the infection risks always present in hospitals and is just more pleasant for patients, too.
In fact, the findings of this study so impressed gastroenterology specialists that leaders in the field are now rethinking their guidelines about PPI use after surgery to repair bleeding ulcers. Meanwhile, physicians are urged to follow established treatment guidelines, but that doesn’t mean that they can’t use their own professional judgment to make treatment decisions. So if you or a loved one ever happens to be in the position of needing surgery for a bleeding ulcer, you may want to ask your gastroenterologist what he or she knows about intermittent versus continuous PPI therapy. Recovering at home may be an option for you.