Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 11, Number 3, June 2018, pages 200-206

Once Versus Twice-Daily Oral Proton Pump Inhibitor Therapy for Prevention of Peptic Ulcer Rebleeding: A Propensity Score-Matched Analysis

**Table 1.** Baseline Patient Characteristics in Patients Discharged on Once Versus Twice-Daily Oral PPI Therapy
	All patients	Propensity score-matched patients
Values between parentheses are percentages unless otherwise specified. Values with a plus/minus sign (±) represent means ± standard deviation. BMI: body mass index; ASA: American Society of Anesthesiologists; NSAID: non-steroidal anti-inflammatory drug; DOAC: direct oral anticoagulant.
Age, mean ± SD	61.6 ± 14	61.1 ± 15.2	0.800	61.6 ± 14	61 ± 14.3	0.821
Male, n (%)	33 (67.4)	90 (48.9)	0.022	33 (67.4)	24 (50)	0.083
Caucasian	44 (90)	160 (87)	0.593	44 (90)	42 (88)	0.721
BMI (kg/m²), median (IQR)	26.5 (23.1 - 31.4)	27.1 (23.2 - 32.5)	0.673	26.5 (23.1 - 31.4)	25.8 (22.3 - 30.3)	0.449
Smokers, n (%)	12 (24.5)	61 (33.1)	0.335	12 (24.5)	16 (33.3)	0.626
Alcohol use	18 (36.7)	67 (36.4)	0.967	18 (36.7)	16 (33.3)	0.726
ASA score (n = 218)			0.011			0.084
1	2 (4.2)	0 (0)		2 (4.2)	0 (0)
2	8 (16.7)	53 (31.2)		8 (16.7)	14 (29.8)
3	29 (60.4)	96 (56.5)		29 (60.4)	30 (63.8)
4	9 (18.8)	21 (12.4)		9 (18.8)	3 (6.4)
Hemodynamic shock	7 (14.3)	41 (22.3)	0.219	7 (14.3)	11 (22.9)	0.274
Presenting symptoms
Melena	32 (65.3)	111 (60.3)	0.525	32 (65.3)	20 (41.7)	0.020
Hematemesis	10 (20.4)	36 (19.6)	0.895	10 (20.4)	11 (22.9)	0.764
Hematochezia	4 (8.2)	26 (14.1)	0.268	4 (8.2)	2 (4.1)	0.414
Syncope	1 (2)	10 (5.4)	0.320	1 (2)	4 (8.3)	0.161
H. pylori status			0.283			0.526
Negative	34 (69.4)	140 (76.1)		34 (69.4)	39 (81.2)
Positive	4 (8.2)	30 (16.3)		4 (8.2)	7 (14.6)
Missing	11 (22.5)	14 (7.6)		11 (22.5)	2 (4.2)
Medications
Aspirin	23 (46.9)	95 (51.6)	0.559	23 (46.9)	27 (56.3)	0.359
Non- aspirin NSAIDs	16 (32.7)	58 (31.5)	0.880	16 (32.7)	16 (33.3)	0.943
Anti-platelet	7 (14.3)	20 (10.9)	0.507	7 (14.3)	6 (12.5)	0.796
DOAC	2 (4.1)	10 (5.4)	0.703	2 (4.1)	2 (4.2)	0.983
Warfarin	7 (14.3)	16 (8.7)	0.244	7 (14.3)	4 (8.3)	0.355
Heparin	2 (4.1)	8 (4.4)	0.935	2 (4.1)	0 (0)	0.157
Steroids	1 (2)	16 (8.7)	0.111	1 (2)	6 (12.5)	0.047

Table 1. Baseline Patient Characteristics in Patients Discharged on Once Versus Twice-Daily Oral PPI Therapy

All patients

Propensity score-matched patients

Once-daily (n = 49)

Twice-daily (n = 184)

P value

Once-daily (n = 49)

Twice-daily (n = 48)

P value

Values between parentheses are percentages unless otherwise specified. Values with a plus/minus sign (±) represent means ± standard deviation. BMI: body mass index; ASA: American Society of Anesthesiologists; NSAID: non-steroidal anti-inflammatory drug; DOAC: direct oral anticoagulant.

Age, mean ± SD

61.6 ± 14

61.1 ± 15.2

0.800

61.6 ± 14

61 ± 14.3

0.821

Male, n (%)

33 (67.4)

90 (48.9)

0.022

33 (67.4)

24 (50)

0.083

Caucasian

44 (90)

160 (87)

0.593

44 (90)

42 (88)

0.721

BMI (kg/m²), median (IQR)

26.5 (23.1 - 31.4)

27.1 (23.2 - 32.5)

0.673

26.5 (23.1 - 31.4)

25.8 (22.3 - 30.3)

0.449

Smokers, n (%)

12 (24.5)

61 (33.1)

0.335

12 (24.5)

16 (33.3)

0.626

Alcohol use

18 (36.7)

67 (36.4)

0.967

18 (36.7)

16 (33.3)

0.726

ASA score (n = 218)

0.011

0.084

2 (4.2)

0 (0)

2 (4.2)

0 (0)

8 (16.7)

53 (31.2)

8 (16.7)

14 (29.8)

29 (60.4)

96 (56.5)

29 (60.4)

30 (63.8)

9 (18.8)

21 (12.4)

9 (18.8)

3 (6.4)

Hemodynamic shock

7 (14.3)

41 (22.3)

0.219

7 (14.3)

11 (22.9)

0.274

Presenting symptoms

Melena

32 (65.3)

111 (60.3)

0.525

32 (65.3)

20 (41.7)

0.020

Hematemesis

10 (20.4)

36 (19.6)

0.895

10 (20.4)

11 (22.9)

0.764

Hematochezia

4 (8.2)

26 (14.1)

0.268

4 (8.2)

2 (4.1)

0.414

Syncope

1 (2)

10 (5.4)

0.320

1 (2)

4 (8.3)

0.161

H. pylori status

0.283

0.526

Negative

34 (69.4)

140 (76.1)

34 (69.4)

39 (81.2)

Positive

4 (8.2)

30 (16.3)

4 (8.2)

7 (14.6)

Missing

11 (22.5)

14 (7.6)

11 (22.5)

2 (4.2)

Medications

Aspirin

23 (46.9)

95 (51.6)

0.559

23 (46.9)

27 (56.3)

0.359

Non- aspirin NSAIDs

16 (32.7)

58 (31.5)

0.880

16 (32.7)

16 (33.3)

0.943

Anti-platelet

7 (14.3)

20 (10.9)

0.507

7 (14.3)

6 (12.5)

0.796

DOAC

2 (4.1)

10 (5.4)

0.703

2 (4.1)

2 (4.2)

0.983

Warfarin

7 (14.3)

16 (8.7)

0.244

7 (14.3)

4 (8.3)

0.355

Heparin

2 (4.1)

8 (4.4)

0.935

2 (4.1)

0 (0)

0.157

Steroids

1 (2)

16 (8.7)

0.111

1 (2)

6 (12.5)

0.047

**Table 2.** Details of Proton Pump Inhibitor Therapy Types, Frequency, and Dosing in the Two Groups
	All patients	Propensity score matched patients
Omeprazole 40 mg	21 (42.8%)	20 (11%)	21 (43%)	4 (8%)
Pantoprazole 40 mg	25 (51%)	160 (87%)	25 (51%)	41 (85%)
Esomeprazole 40 mg	3 (6%)	4 (2%)	3 (6%)	3 (6%)

Table 2. Details of Proton Pump Inhibitor Therapy Types, Frequency, and Dosing in the Two Groups

All patients

Propensity score matched patients

Once-daily (n = 49)

Twice-daily (n = 184)

Once-daily (n = 49)

Twice-daily (n = 48)

Omeprazole 40 mg

21 (42.8%)

20 (11%)

21 (43%)

4 (8%)

Pantoprazole 40 mg

25 (51%)

160 (87%)

25 (51%)

41 (85%)

Esomeprazole 40 mg

3 (6%)

4 (2%)

3 (6%)

**Table 3.** Initial Endoscopic Findings in Patients Discharged on Once Versus Twice-Daily Therapy
	All patients	Propensity score-matched patients
Rockall score, median (IQR)	4 (3 - 5)	4 (3 - 6)	0.259	4 (3 - 5)	4 (3 - 5)	0.858
Forrest class			0.006			0.201
1a	0	9 (4.9)		0	1 (2.1)
1b	4 (8.2)	27 (14.7)		4 (8.2)	5 (10.4)
2a	4 (8.2)	24 (13)		4 (8.2)	4 (8.3)
2b	8 (16.3)	6 (3.2)		8 (16.3)	1 (2.1)
2c	2 (4.1)	13 (7.1)		2 (4.1)	4 (8.3)
3	31 (63.3)	105 (57.1)		31 (63.3)	33 (65.9)
Number of endoscopic treatments			0.282			0.473
0	30 (61.2)	114 (62)		30 (61.2)	33 (68.8)
1	8 (16.3)	24 (13)		8 (16.3)	4 (8.3)
2	11 (22.5)	34 (18.5)		11 (22.5)	10 (20.8)
3	0 (0)	12 (6.5)		0 (0)	1 (1)
Ulcer size, mm			0.373			0.662
Mean ± SD	10.7 ± 7.8	11.3 ± 7.6		10.7 ± 7.8	10.6 ± 7.7
Range	2-30	2-40		2-30	2-40
Ulcer location, n (%)
Gastric	32 (65.3)	112 (60.9)	0.570	32 (65.3)	31 (64.6)	0.941
Duodenal	16 (32.7)	83 (45.1)	0.117	16 (32.7)	19 (39.6)	0.477
Number of ulcers			0.715			0.126
Single ulcer	27 (55.1)	96 (52.2)		27 (55.1)	19 (39.6)
Multiple ulcers	22 (44.9)	88 (47.8)		22 (44.9)	29 (60.4)

Table 3. Initial Endoscopic Findings in Patients Discharged on Once Versus Twice-Daily Therapy

All patients

Propensity score-matched patients

Once-daily (n = 49)

Twice-daily (n = 184)

P value

Once-daily (n = 49)

Twice-daily (n = 48)

P value

Rockall score, median (IQR)

4 (3 - 5)

4 (3 - 6)

0.259

4 (3 - 5)

0.858

Forrest class

0.006

0.201

9 (4.9)

1 (2.1)

4 (8.2)

27 (14.7)

4 (8.2)

5 (10.4)

4 (8.2)

24 (13)

4 (8.2)

4 (8.3)

8 (16.3)

6 (3.2)

8 (16.3)

1 (2.1)

2 (4.1)

13 (7.1)

2 (4.1)

4 (8.3)

31 (63.3)

105 (57.1)

31 (63.3)

33 (65.9)

Number of endoscopic treatments

0.282

0.473

30 (61.2)

114 (62)

30 (61.2)

33 (68.8)

8 (16.3)

24 (13)

8 (16.3)

4 (8.3)

11 (22.5)

34 (18.5)

11 (22.5)

10 (20.8)

0 (0)

12 (6.5)

0 (0)

1 (1)

Ulcer size, mm

0.373

0.662

Mean ± SD

10.7 ± 7.8

11.3 ± 7.6

10.7 ± 7.8

10.6 ± 7.7

Range

2-30

2-40

2-30

2-40

Ulcer location, n (%)

Gastric

32 (65.3)

112 (60.9)

0.570

32 (65.3)

31 (64.6)

0.941

Duodenal

16 (32.7)

83 (45.1)

0.117

16 (32.7)

19 (39.6)

0.477

Number of ulcers

0.715

0.126

Single ulcer

27 (55.1)

96 (52.2)

27 (55.1)

19 (39.6)

Multiple ulcers

22 (44.9)

88 (47.8)

22 (44.9)

29 (60.4)

**Table 4.** Primary and Secondary Outcomes in Patients Discharged on Once Versus Twice-Daily Therapy
	All patients	Propensity score-matched patients
Recurrent bleeding
Within 30 days	7 (14.3)	11 (6)	0.053	7 (14.3)	2 (4.2)	0.159
All-cause mortality
Within 30 days	0 (0)	4 (2.2)	0.582	0 (0)	2 (4.2)	0.242
Blood transfusion requirement
For recurrent bleed	50	47		27	1
Mean (SD)	1.5 (2.1)	1.3 (1.6)	0.584	3.9 (4.5)	0.5 (0.7)	0.445
Additional hospital days for recurrent bleed
Total	47	68		47	6
Mean (SD)	6.7 (4.4)	6.2 (5.2)	0.614	1 (2)	2 (4.2)	0.125
Required IR embolization within 30 days	2 (28.6)	2 (18.2)	1	2 (4.1)	0 (0)	0.495
Required surgery within 30 days	1 (14.3)	0 (0)	0.389	1 (2.1)	0 (0)	0.32

Table 4. Primary and Secondary Outcomes in Patients Discharged on Once Versus Twice-Daily Therapy

All patients

Propensity score-matched patients

Once-daily (n = 49)

Twice-daily (n = 184)

P value

Once-daily (n = 49)

Twice-daily (n = 48)

P value

Recurrent bleeding

Within 30 days

7 (14.3)

11 (6)

0.053

7 (14.3)

2 (4.2)

0.159

All-cause mortality

Within 30 days

0 (0)

4 (2.2)

0.582

0 (0)

2 (4.2)

0.242

Blood transfusion requirement

For recurrent bleed

Mean (SD)

1.5 (2.1)

1.3 (1.6)

0.584

3.9 (4.5)

0.5 (0.7)

0.445

Additional hospital days for recurrent bleed

Total

Mean (SD)

6.7 (4.4)

6.2 (5.2)

0.614

1 (2)

2 (4.2)

0.125

Required IR embolization within 30 days

2 (28.6)

2 (18.2)

2 (4.1)

0 (0)

0.495

Required surgery within 30 days

1 (14.3)

0 (0)

0.389

1 (2.1)

0 (0)

0.32