Intravenous PPI Treatment: A Reflex Action?

Aims: The rationale for using intravenous (IV) proton pump inhibitors (PPI's) stems from their efficacy following endoscopic treatment of bleeding peptic ulcer disease, but an American review suggested that nearly 50% of intravenous pantoprazole use was inappropriate. We assessed appropriateness of IV PPI use in an Irish hospital without current local guidelines.

Methods: A retrospective study of 40 unselected patients (median age 55; range 19–88; 16 female) commenced on IV PPI's in early 2004. Data were retrieved from clinical charts.

Results: 23 patients (58%) had no evidence of haematemesis or melaena and 32 (80%) were haemodynamically stable at commencement. Acid related disease was considered as a diagnosis in 22 cases (55%). Therapy was commenced by A/E (n=5), ICU (n=5), medical (n=15) and surgical (n=15) staff, most commonly by registrars. Duration of use varied from 1 to 29 days (median 3). 21 patients (53%) underwent OGD, but none prior to initiation of treatment. Median time from treatment to OGD was 1 day (0–52). One patient had endoscopic haemostasis of a bleeding ulcer.

Conclusions: IV PPI use appears to be almost entirely inappropriate, haphazard and unsystematic in the absence of local policy. Rational protocols might be valuable in guiding future practice.