Clot lysis by gastric juice: an in vitro study.

Abstract

SUMMARY Gastric juice from patients with peptic ulcer disease and from patients with no upper gastrointestinal abnormality was studied in order to assess its effect on a formed fibrin clot. In both groups of patients gastric juice caused a marked increase in fibrinolysis as evidenced by a shortening of the euglobulin clot lysis time. This plasmin mediated fibrinolytic activity was found to be heat labile and only present in an acid environment. Addition of tranexamic acid or sucralfate to gastric juice almost completely reversed this effect, whereas pepstatin was only partially effective. It is probable that acid dependant proteases other than pepsin are responsible for the marked fibrinolysis. The ulcer healing agent sucralfate might be useful in those patients at risk of bleeding or rebleeding from active peptic ulcer disease.Haemorrhage from active peptic ulcer disease remains a common and difficult therapeutic problem. Despite many new approaches in management, the mortality has changed little over the past 50 years. Approximately 10% of patients with acute upper gastrointestinal bleeding will die' and the mortality rate may rise to over 30% in that subgroup requiring emergency surgery."Th4 poor haemostatic response seen in the bleeding upper gastrointestinal tract has been variously ascribed to increased gastrointestinal motility during haemorrhage,' the marked vascularity and absence of autoregulation of local blood flow,' and the adverse effects of both acid and pepsin on the coagulation cascade.7 Moreover, dissolution of a formed fibrin clot is thought to be responsible for the very high incidence of rebleeding observed. Several investigators have identified fibrinolytic activity in gastric venous blood of patients with gastric haemorrhage`" and in gastric juice of patients with erosive gastroduodenitis."`R ecent work has suggested a beneficial effect of specific antifibrinolytic agents in preventing rebleeding in acute upper gastrointestinal haemorrhage."'" In the present study we have assessed the degree of fibriAddress for correspondencec: D P O'Donoghue,

α1-Antitrypsin Precursor in Gastric Juice Is a Novel Biomarker for Gastric Cancer and Ulcer

“…Multivariate analysis disclosed that gastric hypoacidity and advanced age were independent factors promoting high protein concentrations in gastric juice with odds ratios of 32.9 and 3.2, respectively. It is well known that pepsin is an active proteolytic enzyme in gastric juice with optimal function at a pH of 1.6, inactive but stable at pH 4 to 6, and irreversibly inactive at a pH of >6 (25,26). Protein components in gastric juice are prone to be digested by pepsin in acidic gastric acid.…”

High-dose vs. Low-dose Proton Pump Inhibitors post-endoscopic hemostasis in patients with bleeding peptic ulcer. A meta-analysis and meta-regression analysis

“…At present, proton pump inhibitors (PPIs) for endoscopic hemostasis is the customary treatment regimen, and convincing guidelines, consensus-generated, have endorsed the use of a highdose PPI regimen (80 mg bolus followed by intravenous administration of 8 mg/h for 72 h) after arrest of bleeding for enhanced-risk upper gastrointestinal recurrence of hemorrhage (3,4). The perceived clinical advantage of the high-dose regimen is to progress clot firmness by maintaining the gastric pH more than 6 (5,6). However, when high-dose PPI is contrasted to a low-dose PPI administration after initial control of hemorrhage is accomplished, certain clinical trials (7,8) and two older meta-analyses (9,10) conveyed comparable results in recurrent hemorrhage rate and the demand for surgical management between the high-and low-dose PPI treatments.…”

Description of Prescribing Practices in Patients with Upper Gastrointestinal Bleeding Receiving Intravenous Proton-Pump Inhibitors: A Multicentre Evaluation

“…The optimal dose of intravenous (IV) PPI has been extrapolated from pH studies which suggest that a pH greater than 6 ORIGINAL ARTICLE is critical in stabilizing clots (8)(9)(10). This is consistently achieved with a bolus of 80 mg followed by a continuous infusion of IV PPI, as used in key clinical studies (11).…”