World Gastroenterology Organisation

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Oral vonoprazan appears equivalent to IV PPI for prevention of peptic ulcer rebleeding

Review by Prof. Mark Topazian (USA)

Study Summary 

Intravenous proton pump inhibitors (IV PPI) have become a standard of care in patients with peptic ulcer hemorrhage whose ulcers are at high risk of re-bleeding. IV PPI decreases rebleeding, re-intervention and mortality. Vonoprazan, a potassium-competitive acid blocker, is a more potent acid blocker than oral PPIs. 

In this non-inferiority trial, 194 patients with peptic ulcers at high risk of rebleeding (mainly Forrest IIa/IIb), all of whom had undergone endoscopic hemostatic interventions, including adrenaline injection plus either mechanical or thermal therapies, were randomized after achieving endoscopic hemostasis to receive either a continuous IV infusion of pantoprazole, 8 mg/hour, for 3 days, followed by oral omeprazole 20 mg BID for 28 days, or oral vonoprazan 20 mg BID for 3 days, then once daily for 28 days. Rebleeding rates at 3, 7 and 30 days were statistically similar in the three groups; at 30 days, rebleeding had occurred in 7.1% in the vonoprazan group and 10.4% in the IV PPI group. The authors concluded that oral vonoprazan is non-inferior to IV PPI for prevention of peptic ulcer re-bleeding following endoscopic hemostasis.

Previous studies have not firmly established whether oral PPIs are as effective as IV PPIs for prevention of peptic ulcer rebleeding. This study demonstrated that oral vonoprazan (which may be more cost-effective than IV PPI in some settings) is as effective as a continuous PPI infusion for this indication. 


Geeratragool et al, Gastroenterology, April 5, 2024

This article is available online open access:

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