- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01182597
Oral Versus IV Proton Pump Inhibitor in High-risk Bleeding Peptic Ulcers After Endoscopic Hemostasis
Oral Versus Intravenous Proton Pump Inhibitor Treatment in High-risk Bleeding Peptic Ulcers After Endoscopic Hemostasis: a Prospective Randomized Comparative Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Acute peptic ulcer bleeding remains a therapeutic challenge with significant morbidity and mortality. Endoscopic therapy using various modalities significantly reduces re-bleeding, need for surgery and mortality in patients with peptic ulcer bleeding. Endoscopic therapy achieves successful hemostasis in more than 90% of patients, and re-bleeding occurs in 10-30% of patients. Re-bleeding has an important impact on prognosis. Studies showed adjuvant treatment with proton pump inhibitor (PPI) after initial endoscopic hemostasis reduced recurrent ulcer bleeding. Two consensus documents have endorsed a high-dose PPI regimen (80 mg stat followed by an infusion of 8 mg/h for 72 h). The biologically plausible mechanism of benefit of such a high-dose regimen is to promote clot stability by sustaining the intragastric pH above 6. However, the optimal dose and administration route of proton pump inhibitors (PPI) for the prevention of peptic ulcer rebleeding remains unclear.
The use of IV PPIs adds significantly to the cost of patient care in hospital. Recent studies reported oral PPI may have similar acid suppressive effect as high dose PPI infusion. A prospective trial and a retrospective analysis have shown that oral PPI therapy may also be effective in decreasing rebleeding rates in patients with acute gastrointestinal bleeding due to high-risk peptic ulcer disease, and the magnitude of benefit appears similar to what has been demonstrated with IV PPIs. A meta-analysis reported no difference in the magnitude of risk reduction between the oral- and the intravenous-route. Given the significant cost savings over their IV counterparts, oral PPIs would be an attractive choice of therapy in this situation provided that they have a similar efficacy to IV PPIs. However, no studies have directly compared oral and IV PPI therapy in this setting.
We conducted a head-to-head study, comparing two strategies for PPI administration in the prevention of rebleeding, surgery, and death in patients with high-risk bleeding peptic ulcers in whom successful endoscopic hemostasis was achieved.
Study Type
Enrollment (Anticipated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: Chieh-Chang Chen, MD
- Phone Number: 2200 88655323911
- Email: chiehchang.chen@gmail.com
Study Locations
-
-
-
Dou-liou, Taiwan
- Recruiting
- National Taiwan Univeristy Hospital Yunlin Branch
-
Contact:
- Chieh-Chang Chen, MD
- Phone Number: 88655323911
- Email: chiehchang.chen@gmail.com
-
Taipei, Taiwan
- Not yet recruiting
- National Taiwan Univeristy Hospital
-
Contact:
- Jyh-Ming Liou, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age ≥ 18
- Confirmed ulcer bleeding with Forrest Ia, Ib, IIa
- Endoscopic hemostasis achieved by combined endoscopic hemostasis
- Informed consent obtained
Exclusion Criteria:
- No consent
- Unsuccessful endoscopic treatment
- Upper GI malignancy
- History of subtotal gastrectomy
- Bleeding tendency, platelet count < 80x109/L, prothrombin time INR >1.5
- Myocardial infarction or cerebrovascular accident within one week
- Ulcer bleeding because of mechanical factors (such as, induction of NG tube)
- Malignancy or other advanced disease with a life expectancy of < 6 months
- IV PPI > 40mg within 24hrs before enrollment
- Decompensated liver cirrhosis
- Requiring dialysis
- Pregnant or lactating women
- History of allergy or severe side effects to lansoparzole or pantoprazole
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: IV PPI
Pantoprazole 3.3mg/hr for 72hrs
|
Pantoprazole (Pantoloc) 3.3mg/hr for 72hrs
|
EXPERIMENTAL: Oral PPI
Lansoprazole (Takepron OD) 30mg PO q12h
|
Lansoprazole (Takepron OD) 30mg q12h PO
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical rebleeding
Time Frame: 30 days
|
Clinical rebleeding defines:
|
30 days
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Mortality rate
Time Frame: 30 days
|
30 days
|
Blood transfusion
Time Frame: 30 day
|
30 day
|
Need of surgery
Time Frame: 30 days
|
30 days
|
Lengths of hospital stay
Time Frame: 30 days
|
30 days
|
Collaborators and Investigators
Investigators
- Principal Investigator: Chieh-Chang Chen, MD, National Taiwan University Hospital Yunlin Branch
Study record dates
Study Major Dates
Study Start
Primary Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Pathologic Processes
- Gastrointestinal Diseases
- Stomach Diseases
- Intestinal Diseases
- Duodenal Diseases
- Gastrointestinal Hemorrhage
- Ulcer
- Hemorrhage
- Peptic Ulcer
- Peptic Ulcer Hemorrhage
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Gastrointestinal Agents
- Anti-Ulcer Agents
- Proton Pump Inhibitors
- Dexlansoprazole
- Lansoprazole
- Pantoprazole
Other Study ID Numbers
- 201003039M
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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