Role of Intravenous Omeprazole in Patients with High-Risk Peptic Ulcer Bleeding After Successful Endoscopic Epinephrine Injection: A Prospective Randomized Comparative Trial

Lin, Hwai J.; Yan, Cheng; Perng, Cherng-Kang; Lo, Wen Ching

doi:10.1016/j.gie.2006.03.297

Cited by 21 publications

(28 citation statements)

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“…Highdose PPI therapy was more effective in reducing the volume of blood transfusion compared with ordinary-dose of PPI therapy [11]. There was no significant difference between intravenous and oral PPI therapy.…”

Section: Non-endoscopic Therapymentioning

confidence: 78%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pyloripositive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

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Section: Non-endoscopic Therapymentioning

confidence: 78%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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“…A systematic meta-analysis, based on published controlled data in the medical literature, reported no benefit of neoadjuvant (pre-endoscopic) PPI therapy on rates of rebleeding, salvage surgery for failures of endoscopic hemostasis, or mortality [17] . Adjuvant PPI therapy, administered following diagnostic and/or therapeutic EGD, has been proven effective, as well, leading to a decrease in recurrent PUD bleeding, need for blood transfusion, need for surgery, and duration of hospital stay [3,18,19] . Despite these major impacts, studies have not demonstrated an impact of PPIs on mortality due to UGIH [3,20,21] .…”

Section: Pharmacologic Therapy Prior To Endoscopymentioning

confidence: 99%

Management of non-variceal upper gastrointestinal tract hemorrhage: Controversies and areas of uncertainty

Trawick

Yachimski²

2012

WJG

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Upper gastrointestinal tract hemorrhage (UGIH) remains a common presentation requiring urgent evaluation and treatment. Accurate assessment, appropriate intervention and apt clinical skills are needed for proper management from time of presentation to discharge. The advent of pharmacologic acid suppression, endoscopic hemostatic techniques, and recognition of Helicobacter pylori as an etiologic agent in peptic ulcer disease (PU�) has revolutionized the treatment of UGIH. �espite this, acute UGIH still carries considerable rates of morbidity and mortality. This review aims to discuss current areas of uncertainty and controversy in the management of UGIH. Neoadjuvant proton pump inhibitor (PPI) therapy has become standard empiric treatment for UGIH given that PU� is the leading cause of non-variceal UGIH, and PPIs are extremely effective at promoting ulcer healing. However, neoadjuvant PPI administration has not been shown to affect hard clinical outcomes such as rebleeding or mortality. The optimal timing of upper endoscopy in UGIH is often debated. Upon completion of volume resuscitation and hemodynamic stabilization, upper endoscopy should be performed within 24 h in all patients with evidence of UGIH for both diagnostic and therapeutic purposes. With rising healthcare cost paramount in today's medical landscape, the ability to appropriately triage UGIH patients is of increasing value. Upper endoscopy in conjunction with the clinical scenario allows for accurate decision making concerning early discharge home in low-risk lesions or admission for further monitoring and treatment in higher-risk lesions. Concomitant pharmacotherapy with non-steroidal anti-inflammatory drugs (NSAI�s) and antiplatelet agents, such as clopidogrel, has a major impact on the etiology, severity, and potential treatment of UGIH. Long-term PPI use in patients taking chronic NSAI�s or clopidogrel is discussed thoroughly in this review.

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“…However, a subgroup analysis revealed that patients with actively spurting ulcer bleeds treated with pantoprazole had fewer adverse clinical outcomes than did ranitidine. Finally, a study by Lin et al [51] compared intravenous administration of omeprazole, 40 mg every 6 hours; omeprazole, 40 mg every 12 hours; and cimetidine, 400 mg every 12 hours in patients who had successful endoscopic injection hemostasis therapy for ulcer bleeding. The group receiving omeprazole every 6 hours had fewer rebleeding events and required fewer blood transfusions than the cimetidine group.…”

Section: Low-or Intermediate-risk Stigmatamentioning

confidence: 99%

Gastric acid inhibition in the treatment of peptic ulcer hemorrhage

Ghassemi¹,

Kovacs²,

Jensen

2009

Curr Gastroenterol Rep

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Upper gastrointestinal bleeding from peptic ulcer disease is a common clinical event, resulting in considerable patient morbidity and significant health care costs. Inhibiting gastric acid secretion is a key component in improving clinical outcomes, including reducing rebleeding, transfusion requirements, and surgery. Raising intragastric pH promotes clot stability and reduces the influences of gastric acid and pepsin. Patients with high-risk stigmata for ulcer bleeding (arterial bleeding, nonbleeding visible vessels, and adherent clots) benefit significantly from and should receive high-dose intravenous proton pump inhibitors (PPIs) after successful endoscopic hemostasis. For patients with low-risk stigmata (flat spots or clean ulcer base), oral PPI therapy alone is sufficient. For oozing bleeding (an intermediate risk finding), successful endoscopic hemostasis and oral PPI are recommended. Using intravenous PPIs before endoscopy appears to reduce the frequency of finding high-risk stigmata on later endoscopy, but has not been shown to improve clinical outcomes. High-dose oral PPIs may be as effective as intravenous infusion in achieving positive clinical outcomes, but this has not been documented by randomized studies and its cost-effectiveness is unclear.

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Role of Intravenous Omeprazole in Patients with High-Risk Peptic Ulcer Bleeding After Successful Endoscopic Epinephrine Injection: A Prospective Randomized Comparative Trial

Cited by 21 publications

References 0 publications

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

Management of non-variceal upper gastrointestinal tract hemorrhage: Controversies and areas of uncertainty

Gastric acid inhibition in the treatment of peptic ulcer hemorrhage

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