Upper GI Bleeding and Omeprazole gtt

New England Journal of Medicine
Volume 356:1631-1640
April 19, 2007
Number 16

Omeprazole before Endoscopy in Patients with Gastrointestinal Bleeding

James Y. Lau, M.D., Wai K. Leung, M.D., Justin C.Y. Wu, M.D., Francis K.L. Chan, M.D., Vincent W.S. Wong, M.D., Philip W.Y. Chiu, M.D., Vivian W.Y. Lee, Ph.D., Kenneth K.C. Lee, Ph.D., Frances K.Y. Cheung, M.B., Ch.B., Priscilla Siu, B.Sc., Enders K.W. Ng, M.D., and Joseph J.Y. Sung, M.D.

Background A neutral gastric pH is critical for the stability of clots over bleeding arteries. We investigated the effect of preemptive infusion of omeprazole before endoscopy on the need for endoscopic therapy.

Methods Consecutive patients admitted with upper gastrointestinal bleeding underwent stabilization and were then randomly assigned to receive either omeprazole or placebo (each as an 80-mg intravenous bolus followed by an 8-mg infusion per hour) before endoscopy the next morning.

Results Over a 17-month period, 638 patients were enrolled and randomly assigned to omeprazole or placebo (319 in each group). The need for endoscopic treatment was lower in the omeprazole group than in the placebo group (60 of the 314 patients included in the analysis [19.1%] vs. 90 of 317 patients [28.4%], P=0.007). There were no significant differences between the omeprazole group and the placebo group in the mean amount of blood transfused (1.54 and 1.88 units, respectively; P=0.12) or the number of patients who had recurrent bleeding (11 and 8, P=0.49), who underwent emergency surgery (3 and 4, P=1.00), or who died within 30 days (8 and 7, P=0.78). The hospital stay was less than 3 days in 60.5% of patients in the omeprazole group, as compared with 49.2% in the placebo group (P=0.005). On endoscopy, fewer patients in the omeprazole group had actively bleeding ulcers (12 of 187, vs. 28 of 190 in the placebo group; P=0.01) and more omeprazole-treated patients had ulcers with clean bases (120 vs. 90, P=0.001).

Conclusions Infusion of high-dose omeprazole before endoscopy accelerated the resolution of signs of bleeding in ulcers and reduced the need for endoscopic therapy.

From www.nejm.org

The Incoming Class

Dear residents and interns, the following is the list and some info on the incoming prelims and categoricals for the Department of Internal Medicine at Saint Louis University Hospital accademic year 2007-2008. Some pics to follow hopefully :-)


Abdalla, Yazan A.
University of Jordan
Beirut, Lebanon
Alto/Tenor/soprano Saxophone player; Clarinet/Flute player;
Glass painting

Alkaade, Saad
University of Damascus
Damascus, Syria
Sports:espicialy soccer and basketball; Music:playing guitar; Movies

Allen, Alina Mihaela
Univ de Medicina Si Farm Grigore T. Popa
Iasi, Romania
Hiking, camping, gourmet cooking, gardening, playing guitar.

Aoun, Bernard Georges
Universite Libanaise
Roumieh el Meten,
Lebanon
Coupled with Mireille Jamil El Ters
Internal Medicine
Swimming: i enjoy it both in summer and winter months
Traveling: So far, i'v been to France,Egypt and the United States, soon i'll visit Jordan

Buckhold, Fred R III
Saint Louis University SOM
St. Louis, MO
Some of my interests include reading literature and history, as well as keeping up with current events. I also like listening to music and playing both acoustic and electric guitar. I am also an avid sports fan, and follow college basketball, college football, professional baseball and football. I also to ride my bicycle on various trails around St. Louis, as well as play football,
softball, soccer, and basketball recreationally.

Burns, Sean Michael
Creighton University SOM
Saint Louis, MO
Enjoy running and racing occasionally, traveling both in the US and abroad, skiing, juggling, golfing, playing guitar, watching professional baseball, and spending time with my family.

Chacko, Sonia Mary
Psg Institute of Medical Sciences
Nagpur, India
Cooking Ethnic foods
Art - painting and pottery

Craft, Jeffrey Michael
Northwestern Univ.Feinberg SOM
E. St. Louis, IL
Cooking, Wine collecting, Exercise,
Golf, Swimming

Dennis, Desi Lamont
Vanderbilt University SOM
Decatur, IL
My hobbies include participating in intramural sports, including basketball, softball, and flag football. I also enjoy camping and salsa dancing.

El Ters, Mireille Jamil
Universite Libanaise
Beirut, Lebanon
Coupled with Bernard Georges Aoun
During my free time i like to enjoy my country s great weather,mostly with swimming as well as camping.I enjoy the time spent in nature because it allows me to practice my other hobby: drawing. I'm also in the process of learning to cook,which i hope will be one of my favorite passtime.

Farah, Khalil Wadih Simon
American University of Beirut
Beirut, Lebanon
Playing football, tennis and volleyball. Following sports closely especially football and tennis.
Following world events and staying up to date. Listening to music and reading, especially sports articles.
Spending time with family and friends. Travelling: already visited Cyprus, Greece, lebanon, UAE, England, U.S.A, Finland, San Marino, Germany, Italy.

Gradney, Steven
Saint Louis University SOM
Galveston, TX
I usually try to find time to make it out to Colorado once or twice a year for snowboarding in the winter and wilderness backpacking or rock climbing in the summer. I have been doing this for eight years now and love it. I am also a member of club teams in basketball and indoor soccer with many of my friends. I spend some of my free time at the gym or running. Otherwise, I spend most of my time catching up on the sports I've missed or with my friends and family, (I have 8 brothers).

Hussan, Hisham
University of Damascus
Strasbourg, France
Travel, music, languages, and soccer. Also interested in electronics.

Khalil, Mohammad Omar
University of Jordan
Abu Dhabi,
United Arab Emirates
Chess, Soccer, Computer technology, Reading literature and physics.

Mohammadi, Farnaz
Mahadevappa Rampure Medical College
Yderabad, India
playing tennis

Mutapcic, Lejla
Mayo Medical School
Zenica, Bosnia-
-Herzegovina
*Alpine downhill skiing since 3 years old; member of Ski Club Zenica, Bosnia; competed for my hometown of Zenica since 1990 till 1996 when I immigrated to USA; won Gold Medals in the Junior 2 National Championship Women's Giant Slalom and Slalom in 1996; qualified for Bosnian Olympics team
* running; registered for Chicago marathon, Oct. 2005
* rollerblading and biking
* water sports: skiing, canoeing, rafting

Muzaffar, Razi
Kansas City University of Medicine and Bioscience
Dubai, United
Arab Emirates
Couples: Sana Waheed, Internal Medicine
Outside of medicine my interests include spending time with my wife Sana, who will also enter residency this year, and engaging in outdoor activities. Along with these, I am interested in computers and keeping up with the latest electronic gadgets.

Nallapaneni, Hari Krishna
Guntur Medical College
Guntur, India
*Social Service: Member of Rotary Club of St.Augustine and Life Member of International Red Cross
*Playing Chess
*Amateur Astronomist

Nicholson, Benjamin Patrick
Saint Louis University SOM
Creve Coeur, MO
Professional sports; Tennis; Jogging;
The Middle East; Numismatics; Playing viola

Ronholm, Chad Michael
Saba University
Pekin, IL
Sports: basketball, baseball, football,
Lifting weights, running, water skiing, snow skiing

Russell, Robert LaRon Sr.
Saint Louis University SOM
Chicago, IL
Exercising, playing basketball, reading and spending time with my family
Schell, Jonathan Craven
Saint Louis University SOM Springfield, MO
Golf, fishing, playing basketball recreationally, working on house and yard, visiting with family and friends

Sedagheh Pakravan, Ali
Shahid Beheshti University of Medical Sciences
Oromiyeh, Iran
Traveling, Golf, Soccer and Basketball, Teaching medical students

Shah, Rishi
Univ. of Missouri KC SOM
St. Louis, MO
Music- I love rock 'n' roll, and I've played guitar since I was eight years old. I write my own music whenever I get a chance. Some of my favorite bands/artists include Led Zeppelin, Hendrix, Stevie Ray Vaughan, Pearl Jam, etc.
Sports- I am a big St. Louis sports fan as it is where I grew up, but I love to watch and follow all sports. I have also played many different sports since I was young, including tennis, football, basketball, and hockey.
Movie-watching- Another favorite pastime of mine.

Sturm, Jacquelyn Michelle
Univ. of Missouri KC SOM
St. Louis, MO
Reading novels, running, swimming, and needlepoint

Tyus, Kimberly Kay
Saint Louis University SOM
Decatur, IL
Cooking and baking breads,
Gardening,particularly roses and vegetables, Reading, Writing/Journaling, Home decorating, Antiquing/Collecting
Walking, Organizing projects

Vaddi, Sirisha
Univ. of Missouri KC SOM
St. Louis, MO
Snow Skiing, Water Skiing and other water sports: wake boarding, swimming, parasailing, scuba diving, and boating, Movies

Waheed, Sana Taj
University of Washington SOM
Providence, RI
Couples: Razi Muzaffar, Radiology, Internal Medicine
Growing up in Wyoming, I love the outdoors. My interests and hobbies include: spending time with my husband and our families, hiking, camping, fishing, horseback riding, and snowmobiling. I also enjoy creating artwork, making traditional Indian cuisine and entertaining, playing with our cat Xena, international travel, cultural events, reading, watching movies, and shopping.

Walshauser, Mark Andrew
Ross University
St. Louis, MO
Running, Weightlifting, Outdoor Activities, and Biking.

Zeinati, Chadi
American University of Beirut
Alexandria, Egypt
music ( I play guitar and Bass guitar), photography, SCUBA diving, Floklore dancing

Zongolowicz, Amy Joan
Saint Louis University SOM
Kenosha, WI
When I have free time, I most enjoy being active outside. This can be as simple as a jog or stroll through the park, or involve an all day hiking trip or camping. I love to go biking or canoeing as well. For when I am indoors, I enjoying reading. I enjoy a wide variety of books including novels, medical books, biographies and history books. I also enjoy listening to music, going to concerts and trying new restaurants.