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

Abstract

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.

Intermittent versus Continuous Pantoprazole Infusion in Peptic Ulcer Bleeding: A Prospective Randomized Study

“…At low pH, acid and pepsin actually digest clots. Since parietal cells maintain intragastric acidity, persistence of intragastric pH at ≥6 must be acquired by inhibition of the every parietal cell [7]. …”

Varis dışı üst gastrointestinal sistem kanamalı hastaların demografik ve klinik özellikleri

“…Akut üst G‹S kanamalar›n›n tedavisi resüsitasyon, kanama yerinin tespiti, kanaman›n durdurulmas›, kanama tekrar›n›n önlenmesi aflamalar›n› kapsamaktad›r (8,9). Hastalar tekrar kanama ve mortalite riskine göre düflük riskli ve yüksek riskli olarak kategorize edilmelidir.…”

High-Throughput Screening of Potassium-Competitive Acid Blockers

“…9,10 PPI therapy is insufficient for the pH control needed for preventing rebleeding after endoscopic hemostasis of patients with gastrointestinal bleeding. 11,12 Moreover, because the hepatic metabolism of PPIs is dependent on the CYP2C19 system, they are affected by the CYP2C19 genetic polymorphism and may have potential for clinically significant pharmacokinetic drug interactions such as those with clopidogrel. 13 To discover novel compounds with alternative mechanisms of H + ,K + -ATPase inhibition and the potential to overcome such limitations of PPIs, we focused on K + competition.…”