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Omeprazole Improves Outcome in GI Bleed

Length of stay and need for endoscopic intervention were reduced, but rebleeding rates and need for surgery were not.

Given that clot stability is affected by gastric pH, investigators hypothesized that preemptive use of proton-pump inhibitors before endoscopy would be beneficial in the management of upper gastrointestinal bleeding. The researchers randomized 638 patients after stabilization to receive intravenous infusion of placebo or omeprazole given as an 80-mg bolus followed by continuous infusion of 8 mg/hour until endoscopy.

Patients who required ulcer hemostasis received continuous infusion for 3 days, followed by oral therapy. Patients who could not be stabilized, who needed urgent surgical intervention, or who were taking long-term aspirin therapy were excluded. Warfarin-induced coagulopathy was reversed, if necessary.

The primary endpoint of need for endoscopic therapy at the first endoscopy was significantly lower in the omeprazole group than in the placebo group (19% vs. 28%). The omeprazole group also had a greater percentage of patients with hospital stays of fewer than 3 days (60.5% vs. 49.2%). However, no differences between groups were found in other secondary endpoints: transfusion requirement, rebleeding, need for surgery, or death at 30 days.

Comment: The reductions in the need for endoscopic intervention and length of stay warrant adoption of this protocol. Need for surgery was not reduced, however, implying that severe bleeding is not significantly affected by omeprazole infusion and that we need to remain vigilant with these patients.

— J. Stephen Bohan, MD, MS, FACP, FACEP

Published in Journal Watch Emergency Medicine May 4, 2007

Citation(s):

Lau JY et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 2007 Apr 19; 356:1631-40.

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