High dose versus low dose intravenous pantoprazole in bleeding peptic ulcer: a randomized clinical trial

The appropriate dose of proton pump inhibitors for treatment of patients with upper [GI] bleeding remains controversial. This study compares high-dose versus low-dose intravenous proton pump inhibitor [PPI] infusion for prevention of GI bleeding complications. A total of 166 patients with bleeding peptic ulcers underwent therapeutic endoscopy using concomitant therapy by argon plasma coagulation [APC] and diluted epinephrine injection. Patients were randomly divided into two groups: high-dose pantoprazole [80 mg bolus, 8 mg per hour] and low-dose pantoprazole [40 mg bolus, 4 mg per hour] infused for three days. Initial outcomes were rebleeding, need for surgery, hemoglobin drop more than two units, and hospitalization for more than five days. Secondary outcome included mortality rate. Overall, 166 patients [83 patients per group] enrolled in the study. The average age of patients in the high-dose group was 59.5 +/- 15.6 years and 52.3 +/- 13.3 years in the low-dose group [p=0.58]. Males comprised 69.7% of patients. In the high-dose group, the mean number of units of transfused blood was 3.3 +/- 1.71 and in the low-dose group, it was 2.82 +/- 1.73 [p=0.50]. There were 36 [43.37%] patients in the high-dose group and 40 [48.19%] in the low-dose group who were hospitalized for more than 5 days [p=0.53]. Rebleeding was observed in 27 [32.53%] patients in the high-dose group and in 21 [25.30%] in the low-dose group [p=0.30]. There were no significant differences observed in drop in hemoglobin of more than two units [p=0.15], mortality [p=0.99] and surgery [p=0.75] between the two groups. For controlling peptic ulcer bleeding, there is no difference between high dose and low dose pantoprazole infusion

Evaluation of N-acetyl cysteine for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a prospective double blind randomized pilot study

Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography [ERCP] that can occasionally be fatal. Multiple drugs have been examined for the prevention of this side effect, with generally uncertain results. This study is an effort to prevent this complication by the use of oral N-acetyl cysteine [NAC]. A total of 100 patients who were candidates for ERCP were divided randomly into two groups. In the NAC [N] group, patients received 1200 mg NAC with 150 cc water orally 2 h before ERCP. In the placebo [P] group, 150 cc water was prescribed as a placebo. We measured serum amylase and lipase levels before and 24 h after ERCP. The prevalence of pancreatitis and duration of admission in each group were determined and compared. In group N there were 5 [10%] cases of pancreatitis, whereas in group P there were 14 [28%] cases, which was significant [risk reduction ratio: 2.8; p=0.02].The average admission time was 1.16 +/- 0.55 days in group N and 1.18 +/- 0.44 days in group P, which was not significant. There were significant differences in the prevalence of acute pancreatitis between the two groups. In addition, the number of need to treat [NNT] consisted of five cases for NAC. With regards to the above results and the safety profile of NAC, it could be used as a therapeutic agent for the prevention of post-ERCP pancreatitis. We recommend that the results of this study be verified by additional clinical trials

[Evaluation of the efficacy of intra-nasal midazolam for sedation during upper endoscopy: a randomized clinical pilot study]

Background: upper endoscopy, as an important diagnostic and occasional therapeutic tool is invasive. Sedation of patients during the endoscopy procedure with minimal side effects could raise patient tolerability, allowing for ease and increased effectiveness of this procedure

Materials and Methods: in this study, 105 patients who were candidates for the upper endoscopy procedure were randomly divided into two groups: [A] midazolam [n=53] and [B] placebo [n=52]. Group A patients received 5 mg of midazolam dissolved in 5 cc distilled water and group B received 5 cc of distilled water, via an intra-nasal drip. After 40 to 45 minutes, the upper endoscopy was performed. During the endoscopy, patients were monitored and the endoscopy time, gag reflex stimulation, heart rate, arterial oxygen saturation [SPO2], amnesia and patient justification were recorded and compared

Results: the average age in group A was 39.3 years; for group B, it was 39.9 years. There were no statistically significant results for average endoscopy time [p=0.23], gag reflex stimulation [p=0.27], heart rate [p=0.09], SPO2 [p=0.49], amnesia [p=0.12], and patient justification [p= 0.1] between both groups

Conclusion: according to the results of this study, it seems that intra-nasal midazolam is not effective for patient sedation. This field needs additional evaluation