Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2025; 17(6): 104234
Published online Jun 16, 2025. doi: 10.4253/wjge.v17.i6.104234
Intravenous proton pump inhibitors vs oral potassium competitive acid blockers before endoscopic treatment of bleeding peptic ulcers
Na Rae Lim, Woo Chul Chung
Na Rae Lim, Woo Chul Chung, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University, Seoul 16247, South Korea
Author contributions: Chung WC conceptualized the study, designed the methodology, performed the formal analysis, revised and edited the sequential versions of the manuscript, and supervised the project; Lim NR performed the data curation and investigation, and drafted the original manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of St. Vincent’s Hospital, Catholic University of Korea, approval VC24RISI0116.
Informed consent statement: Informed consent was waived due to retrospective feature of study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Further information is available from the corresponding author upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Woo Chul Chung, MD, PhD, Professor, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University, Jungbu-daero 93, Seoul 16247, South Korea. jwchulkr@catholic.ac.kr
Received: December 16, 2024
Revised: March 29, 2025
Accepted: May 13, 2025
Published online: June 16, 2025
Processing time: 179 Days and 14.6 Hours
Abstract
BACKGROUND

The use of proton pump inhibitors (PPIs) with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.

AIM

To compare intravenous PPIs and oral potassium competitive acid blockers (PCABs) administered prior to endoscopic treatment of bleeding peptic ulcers.

METHODS

This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding (treated August 2023 to February 2024). Prior to emergency endoscopy, patients received either intravenous PPI (pantoprazole 80 mg bolus) or oral PCAB (tegoprazan 50 mg single-dose). Severity of bleeding was assessed using the Glasgow-Blatchford, Rockall, and AIMS65 scoring systems. Patients with severe comorbidities were excluded. Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding. Multivariate logistic regression was performed to adjust for potential confounding factors.

RESULTS

Total of the 105 patients, 61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy. To minimize selection bias, bleeding severity was assessed using the Glasgow-Blatchford, Rockall and AIMS65 scores, with no statistically significant differences observed between the two groups. During emergency endoscopy performed within 48 hours, ulcer bed status was classified according to the Forrest classification. The proportion of lesions graded IIa or higher was significantly lower in the PCAB group (P < 0.001), as was the frequency of therapeutic endoscopy intervention (odds ratio = 0.272, 95% confidence interval: 0.111-0.665, P = 0.004). The frequency of re-bleeding events was statistically significantly higher in the PPI group (odds ratio = 0.141, 95% confidence interval: 0.024-0.844, P = 0.032).

CONCLUSION

Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.

Keywords: Peptic ulcer; Bleeding; Proton pump inhibitor; Potassium competitive acid blocker; Ulcer bleeding

Core Tip: This study compared the effectiveness of intravenous proton pump inhibitors (PPIs) and oral potassium competitive acid blockers (PCABs) in managing non-variceal upper gastrointestinal bleeding prior to emergency endoscopy. PPI injection and PCAB administration groups showed no significant differences in bleeding severity. However, the PCAB group demonstrated significantly fewer ulcer lesions with recent bleeding stigmata and required fewer therapeutic endoscopic interventions. Additionally, re-bleeding events were more frequent in the PPI group. These findings suggest that pre-endoscopic administration of PCABs may be more effective than PPIs and could potentially reduce mortality associated with ulcer bleeding.