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Editor's Correspondence |

High or Low Doses of PPIs for Patients With Peptic Ulcer Bleeding?

Hwai-Jen Lin, MD
Arch Intern Med. 2010;170(18):1699-1700. doi:10.1001/archinternmed.2010.353.
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I read with interest the article by Wang et al1 titled “High-Dose vs Non–High-Dose Proton Pump Inhibitors After Endoscopic Treatment in Patients With Bleeding Peptic Ulcer.” The authors analyzed 1157 patients from 7 randomized studies and found that non–high-dose and high-dose PPI groups had similar rebleeding episodes, surgical intervention, and mortality rates after endoscopic therapy.

However, these results are different from the international consensus and previous observation of mine and my colleagues. Several points require further clarification. First, endoscopic hemostatic therapy is not indicated for patients with low-risk stigmata (eg, a clean-based ulcer or a nonprotuberant pigmented dot in an ulcer base) who have a low rebleeding rate.2,3 Unfortunately, Wang et al1 have cited some studies that included low-risk patients: Yilmaz et al4 included 190 patients with low-risk stigmata (clean base, n = 144; flat pigmented spots, n = 46), while Bajaj et al5 included 11 patients (44%) with low-risk stigmata. In these low-risk patients, rebleeding rates may be similar with either high or low doses of PPIs. Therefore, the conclusion of Wang et al1 may be misleading.

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