A comparison of omeprazole and placebo for bleeding peptic ulcer

Khuroo, M. S.; Yattoo, Ghulam Nabi; Javid, Gul; Ba, Khan; Shah, AA; Gulzar, GM

doi:10.1016/s0016-5107(98)90003-1

Cited by 98 publications

(153 citation statements)

References 0 publications

Supporting

Mentioning

144

Contrasting

Unclassified

Order By: Relevance

“…However, even with the use of a intravenous proton-pump inhibitor and epinephrine injection therapy, this study reported a surprisingly high rate of recurrent bleeding (75%) for patients with nonbleeding visible vessels. The exceptionally high recurrent bleeding rate in this study of ulcers with nonbleeding visible vessels is difficult to explain since it is even higher than the untreated group (55.6%) in a prior placebo-controlled trial with oral proton-pump inhibitor [35].…”

Section: Discussioncontrasting

confidence: 61%

Endoscopic Doppler Ultrasound Versus Endoscopic Stigmata-Directed Management of Acute Peptic Ulcer Hemorrhage: A Multimodel Cost Analysis

Chen

Wong

2006

Dig Dis Sci

View full text Add to dashboard Cite

Recurrent bleeding from acute peptic ulcer hemorrhage is problematic. Studies have shown that Doppler ultrasound (DOP-US) is useful in decreasing rebleeding. We analyzed associated costs and outcomes to better define the role of DOP-US versus Conventional (Forrest classification endoscopic stigmata) in the management of acute peptic ulcer bleeding. Two separate decision analyses were constructed. Recurrent bleeding, failed esophagogastroduodenoscopy (EGD) hemostasis, complications, and surgery rates were derived from medical literature. Costs were based on Medicare data. DOP-US is preferred over Conventional in acute peptic ulcer bleeding with average cost savings per patient ranging from 853 dollars (decision-tree modeling) to 1,160 dollars (Monte Carlo simulation). High-dose intravenous proton-pump inhibitors lowered rates of recurrent bleeding for both Conventional and DOP-US, resulting in a lower but still persistent average cost savings per patient for DOP-US (decision-tree modeling = 328 dollars, Monte Carlo simulation = 560 dollars). This decision analyses identified DOP-US as the preferred cost-minimizing strategy in acute peptic ulcer hemorrhage. Results of cost analyses were most dependent on hospitalization costs and recurrent bleeding rates.

show abstract

Section: Discussioncontrasting

confidence: 61%

Endoscopic Doppler Ultrasound Versus Endoscopic Stigmata-Directed Management of Acute Peptic Ulcer Hemorrhage: A Multimodel Cost Analysis

Chen

Wong

2006

Dig Dis Sci

View full text Add to dashboard Cite

show abstract

“…The rebleeding rate of an ulcer with an adherent clot in patients undergoing standard medical therapy is high (i.e., in the range of 20 to 35%, with 95% confidence intervals for pooled data ranging from 20 to 39%) (1, 38). Khuroo et al reported a rebleeding rate of zero with oral omeprazole alone (40 mg twice daily) (20), which is comparable to the 0 to 5% rebleeding rate achieved by endoscopic therapy alone (41,42). It is important to note that the definition of an adherent clot is not standardized (42).…”

Section: Discussionmentioning

confidence: 90%

“…The frequency of rebleeding from nonbleeding visible vessels in patients undergoing "standard medical therapy" (i.e., intravenous H 2 -receptor antagonists and later oral proton pump inhibitors) ranges from 40 to 50%, with 95% confidence intervals from pooled data ranging from 27 to 52% (1,36,38). As previously mentioned, Khuroo et al showed in a post hoc subgroup analysis that 40 mg of oral omeprazole twice daily alone reduced the rebleeding rate of ulcers with nonbleeding visible vessels to 11.8% (20), which is comparable to the rebleeding rate of 17 to 19% achieved by endoscopy alone (39,40). Grosso et al directly compared the two therapies in 42 patients with nonbleeding visible vessels in peptic ulcers randomized to endoscopic injection therapy and standard medical therapy (which included intermittent intravenous ranitidine) or intravenous omeprazole (40 mg twice daily for 2 days) followed by oral omeprazole at 40 mg daily (40).…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Appropriate Use of Intravenous Proton Pump Inhibitors in the Management of Bleeding Peptic Ulcer

Julapalli

Graham

2005

Dig Dis Sci

View full text Add to dashboard Cite

Rebleeding from peptic ulcers is a major unsolved problem in the management of acute upper gastrointestinal bleeding. Our goal was to review what is known and what remains to be learned about the effectiveness of antisecretory therapy for acute upper gastrointestinal bleeding. We reviewed the data regarding the effectiveness of endoscopic therapy, the prediction of those at increased risk for rebleeding, and the effectiveness of antisecretory drug therapy in preventing rebleeding with or without endoscopic hemostasis. Proton pump inhibitor therapy without endoscopic hemostasis is ineffective clinically for stopping bleeding or preventing rebleeding. Endoscopic hemostasis remains the cornerstone of therapy. The data are consistent with the notion that reliable maintenance of the intragastric pH at > or = 6 after endoscopic hemostasis is associated with the lowest rebleeding rates. H2-receptor antagonists are ineffective for achieving this goal. Intermittent bolus and oral administration of proton pump inhibitors are equivalent and fail to achieve this goal, which can only be accomplished by bolus administration of a proton pump inhibitor (e.g., 80 mg) followed by a constant infusion (e.g., 8 mg/hr). Whether the combination of endoscopic hemostasis and pH control is equal or superior to selected second-look endoscopy is unknown. A treatment algorithm is suggested.

show abstract

“…In 1997, Khuroo and associates [18] first described the effectiveness of proton pump inhibitors in the acute management of nonvariceal upper gastrointestinal bleeding. This randomized, blinded, placebo-controlled study of 220 patients examined the effects of 40 mg omeprazole given orally twice daily on bleeding peptic ulcers.…”

Section: Medical Therapy For Nonvariceal Upper Gastrointestinal Bleedingmentioning

confidence: 99%

Current therapy for nonvariceal upper gastrointestinal bleeding

2004

View full text Add to dashboard Cite

Upper gastrointestinal bleeding continues to plague physicians despite the discovery of Helicobacter pylori and advances in medical therapy for peptic ulcer disease. Medical therapy with new nonsteroidal anti-inflammatory medications and somatostatin/octreotide and intravenous proton pump inhibitors provides hope for reducing the incidence of and treating bleeding peptic ulcer disease. Endoscopic therapy remains the mainstay for diagnosis and treatment of upper gastrointestinal bleeding. Many methods of endoscopic hemostasis have proven useful in upper gastrointestinal hemorrhage. Currently, combination therapy with epinephrine injection and bicap or heater probe therapy is most commonly employed in the United States. Angiography and embolization play a role primarily when endoscopic therapy is unsuccessful.

show abstract

A comparison of omeprazole and placebo for bleeding peptic ulcer

Cited by 98 publications

References 0 publications

Endoscopic Doppler Ultrasound Versus Endoscopic Stigmata-Directed Management of Acute Peptic Ulcer Hemorrhage: A Multimodel Cost Analysis

Endoscopic Doppler Ultrasound Versus Endoscopic Stigmata-Directed Management of Acute Peptic Ulcer Hemorrhage: A Multimodel Cost Analysis

Appropriate Use of Intravenous Proton Pump Inhibitors in the Management of Bleeding Peptic Ulcer

Current therapy for nonvariceal upper gastrointestinal bleeding

Contact Info

Product

Resources

About