Omeprazole before Endoscopy in Patients with Gastrointestinal Bleeding

In this randomized study of patients with upper gastrointestinal bleeding, infusion of omeprazole, as compared with placebo, before endoscopy reduced the incidence of endoscopic treatment (19.1% vs. 28.4%, P=0.007) and, among patients with peptic ulcers, resulted in fewer actively bleeding ulcers an...

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Veröffentlicht in:The New England journal of medicine 2007-04, Vol.356 (16), p.1631-1640
Hauptverfasser: Lau, James Y, Leung, Wai K, Wu, Justin C.Y, Chan, Francis K.L, Wong, Vincent W.S, Chiu, Philip W.Y, Lee, Vivian W.Y, Lee, Kenneth K.C, Cheung, Frances K.Y, Siu, Priscilla, Ng, Enders K.W, Sung, Joseph J.Y
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Sprache:eng
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Zusammenfassung:In this randomized study of patients with upper gastrointestinal bleeding, infusion of omeprazole, as compared with placebo, before endoscopy reduced the incidence of endoscopic treatment (19.1% vs. 28.4%, P=0.007) and, among patients with peptic ulcers, resulted in fewer actively bleeding ulcers and more ulcers with clean bases. These findings suggest that infused omeprazole is beneficial for patients with upper gastrointestinal bleeding who are awaiting endoscopy. In patients with upper gastrointestinal bleeding, infusion of omeprazole before endoscopy reduced the incidence of endoscopic treatment (19.1% vs. 28.4%) and, among patients with peptic ulcers, resulted in fewer actively bleeding ulcers and more ulcers with clean bases. In patients with bleeding peptic ulcers, we previously showed that infusion of a high-dose proton-pump inhibitor after hemostasis had been achieved during endoscopy reduced recurrent bleeding and improved clinical outcomes. 1 The adjuvant use of high-dose proton-pump inhibitors in endoscopic therapy has also been endorsed in two consensus statements 2 , 3 and confirmed in two meta-analyses. 4 , 5 Clot formation over arteries is pH dependent; a gastric pH above 6 is thought to be critical for platelet aggregation. 6 When given intravenously and at a high dose, proton-pump inhibitors can be used to maintain a neutral gastric pH. 7 In clinical practice, treatment with proton-pump . . .
ISSN:0028-4793
1533-4406
DOI:10.1056/NEJMoa065703