Clinical trial: intravenous pantoprazole vs. ranitidine for the prevention of peptic ulcer rebleeding: a multicentre, multinational, randomized trial

Abstract

SUMMARY BackgroundControlled pantoprazole data in peptic ulcer bleeding are few.

Management of Acute Gastric Ulcer Bleeding

“…Many well-conducted, randomized controlled trials, metaanalyses, and consensus conferences have confirmed the efficacy of endoscopic therapy in this setting (Sacks HS et al 1990;Cook DJ et al, 1992). These data supported a reduction in recurrent bleeding, the need for urgent surgery, and mortality in patients with high-risk stigmata (Barkun et al, 2003;Adler et al, 2004). However, most of these studies were conducted before the widespread use of PPIs, and predominantly used injection therapy, bipolar-probe coagulation therapy, or a combination of injection and coagulation therapy.…”

“…Proton pump inhibitors initiated after endoscopic haemostasis of bleeding peptic ulcer significantly reduced rebleeding compared with placebo or H 2 -receptor antagonists (Sung et al, 2009;van Rensburg et al, 2009). The initiation of PPIs before endoscopy significantly decreases the proportion of patients with stigmata of a recent bleed (e.g.…”

“…Pantoprazole given as an initial 80-mg bolus injection, followed by 8 mg/h continuous infusion, seems to be the adequate treatment in patients with a high risk of rebleeding. Compared to an initial 80 mg-bolus injection, followed by 6-mg/h continuous insion, it demonstrated a lower inter-individual variability of intra-gastric pH and the pH was ≥ 6 for a greater percentage of time (van Rensburg et al 2003). About five percent of patients with peptic ulcer bleeding responded poorly to intravenous omeprazole with rebleeding rates higher in patients with a mean intra-gastric pH of less than 6 (Hsieh et al, 2004).…”

“…A planned, second-look endoscopy within 24 hours after initial endoscopic therapy is not recommended on the basis of existing evidence (Barkun et al 2003;Adler et al 2004). Even though it proofed to be efficacious in two meta-analyses that second-look endoscopy with heater probe coagulation reduces the risk of recurrent bleeding, it had no overall effect on mortality or the need for surgery (Marmo et al 2003;Tsoi et al 2009).…”

Effect of rebamipide on gastric bleeding and ulcerogenic responses induced by aspirin plus clopidogrel under stimulation of acid secretion in rats

“…[2][3][4] Antisecretory drugs such as proton pump inhibitors (PPIs) or histamine H2 receptor antagonists are effective in preventing the upper GI bleeding induced by the concomitant use of antiplatelet drugs with NSAIDs and low-dose ASA. [5][6][7][8] The antiplatelet drug clopidogrel is a prodrug, the actions of which may be related to adenosine diphosphate (ADP) receptors on platelet cell membranes. 9 This drug specifically and irreversibly inhibits the P2Y12 subtype of the ADP receptor, which is important for the aggregation of platelets and cross-linking by the protein fibrin.…”