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| |  High-Dose Intravenous Omeprazole Often Stops Gastric Bleeding Without Further Therapy By W. A. Thomasson, PhD CHICAGO, IL -- May 23, 2005 -- Intravenous administration of high-dose omeprazole to patients with overt signs of upper gastrointestinal bleeding significantly reduces the frequency of active bleeding at later endoscopy, say researchers. Presenting data on May 16th here at Digestive Disease Week (DDW), James Y. K. Lau, MB, consult at Prince of Wales Hospital, Chinese University of Hong Kong, in Hong Kong, China, said that he and his colleagues attribute this effect to pH dependence of platelet aggregation and pepsin activity. The study encompassed 648 consecutive patients, with 160 chronic aspirin users being entered into a different trial and 117 patients excluded for other reasons including need for immediate endoscopy and moribundity. After volume resuscitation, the 371 remaining patients were randomized to receive either placebo or an 80-mg omeprazole bolus followed by 8 mg/hr. Two hundred twenty-two of these patients (110 omeprazole, 112 placebo) were documented as having bleeding peptic ulcers and included in the evaluated population. Baseline characteristics were comparable in the 2 treatment groups. At scheduled endoscopy, usually the following morning, only 20 omeprazole patients had stigmata of bleeding, including 4 with clots and 13 with a nonbleeding visible vessel. By contrast, 41 placebo patients had stigmata of bleeding, including 15 with oozing and 3 with spurting vessels. The remaining patients in each group had lesions with flat pigment and a clean base that did not require therapy. This reduction in number of patients with evidence of bleeding was statistically significant (P = .003). There were also nonsignificant reductions in mean hospital stay (3.7 vs 4.7 days), need for surgery (1 case vs 4), and difficulty of endoscopic therapy (4.2 vs 5.1 on visual analog scale). There was little or no difference in transfusion, frequency of recurrent bleeding, or 30-day mortality. Thus, Dr. Lau concluded, "Preemptive use of high-dose omeprazole has a hemostatic effect, hastens resolution of stigmata of bleeding, and reduces need for endoscopic therapy." Considering data from all treated patients, not just those with bleeding peptic ulcers, he also concluded that the approach enables early patient discharge and reduces utilization of hospital resources.
[Presentation title: Early Administration of High-Dose Intravenous Omeprazole Prior to Endoscopy in Patients With Upper Gastrointestinal Bleeding, a Double Blind Placebo Controlled Randomized Trial. Abstract 347]
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