Saturday, April 21, 2007

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.



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