Background A neutral gastric pH is critical for the stabilityof clots over bleeding arteries. We investigated the effectof preemptive infusion of omeprazole before endoscopy on theneed for endoscopic therapy.
Methods Consecutive patients admitted with upper gastrointestinalbleeding underwent stabilization and were then randomly assignedto receive either omeprazole or placebo (each as an 80-mg intravenousbolus followed by an 8-mg infusion per hour) before endoscopythe next morning.
Results Over a 17-month period, 638 patients were enrolled andrandomly assigned to omeprazole or placebo (319 in each group).The need for endoscopic treatment was lower in the omeprazolegroup than in the placebo group (60 of the 314 patients includedin the analysis [19.1%] vs. 90 of 317 patients [28.4%], P=0.007).There were no significant differences between the omeprazolegroup and the placebo group in the mean amount of blood transfused(1.54 and 1.88 units, respectively; P=0.12) or the number ofpatients who had recurrent bleeding (11 and 8, P=0.49), whounderwent emergency surgery (3 and 4, P=1.00), or who died within30 days (8 and 7, P=0.78). The hospital stay was less than 3days in 60.5% of patients in the omeprazole group, as comparedwith 49.2% in the placebo group (P=0.005). On endoscopy, fewerpatients in the omeprazole group had actively bleeding ulcers(12 of 187, vs. 28 of 190 in the placebo group; P=0.01) andmore omeprazole-treated patients had ulcers with clean bases(120 vs. 90, P=0.001).
Conclusions Infusion of high-dose omeprazole before endoscopyaccelerated the resolution of signs of bleeding in ulcers andreduced the need for endoscopic therapy. (ClinicalTrials.govnumber, NCT00164866
[ClinicalTrials.gov]
.)
Source Information
From the Institute of Digestive Disease (J.Y.L., W.K.L., J.C.Y.W., F.K.L.C., V.W.S.W., P.W.Y.C., F.K.Y.C., P.S., E.K.W.N., J.J.Y.S.) and the School of Pharmacy (V.W.Y.L., K.K.C.L.), Chinese University of Hong Kong, Shatin, Hong Kong, China.
Address reprint requests to Dr. Lau at the Department of Surgery, 4th Fl., Clinical Science Bldg., Prince of Wales Hospital, 32 Ngan Shing St., Shatin NT, Hong Kong, China, or at laujyw{at}surgery.cuhk.edu.hk.
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