Controlled trial of medical therapy for active upper gastrointestinal bleeding and prevention of rebleeding

Zuckerman, Gary R.; Welch, Richard W.; Douglas, A.G.; Troxell, Rebecca; Cohen, Sidney; Lorber, Stanley H.; Melnyk, Clifford S.; Bliss, Charles M.; Christiansen, P. A.; Kern, Fred

doi:10.1016/0002-9343(84)90652-1

Cited by 58 publications

(17 citation statements)

References 17 publications

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“…omeprazole, which are more potent inhibitors of acid secretion that the H 2 -receptor antagonists, were introduced later. However, neither H 2 -antagonists nor PPIs reduce gastric/mucosal blood flow and hence are unlikely to be useful in the control of bleeding [43,106,107]. A meta-analysis of 27 published trials on the use of H 2 -receptor antagonists in patients with suggested that these drugs only marginally reduced the need for surgery and mortality compared to other medical therapies or placebo [108].…”

Section: Histamine (H 2 )-Receptor Antagonists and Proton Pump Inhibimentioning

confidence: 99%

Drug Therapy for Non-Variceal Upper Gastrointestinal Bleeding

Jenkins¹

1999

Digestion

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Section: Histamine (H 2 )-Receptor Antagonists and Proton Pump Inhibimentioning

confidence: 99%

Drug Therapy for Non-Variceal Upper Gastrointestinal Bleeding

Jenkins¹

1999

Digestion

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“…in most studies this elevated pH has not been successfully maintained [<S], and it has not been possible to show that antacids, cirnetidinc or ranitidine have been significantly bet ter than placebo in controlling active bleeding. Furthermore, any demonstration of clinical significance is complicated by the fact that up to 75% of patients entered into clinical studies with upper gastrointestinal bleeding will spon taneously stop bleeding [9,10].…”

Section: Treatment O F Bleeding Peptic Ulcersmentioning

confidence: 99%

Clinical Development Programme for Omeprazole

Walan¹

1990

Digestion

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Omeprazole has been shown to provide more rapid symptom relief and to heal ulcers more quickly and reliably than H₂-receptor antagonists in duodenal ulcer, gastric ulcer and reflux oesophagitis. In addition, omeprazole is well tolerated and has a good safety profile. Among the areas for clinical development with omeprazole are the maintenance treatment of duodenal ulcer, treatment of non-steroidal anti-inflammatory drugs (NSAID)-induced gastroduodenal lesions, maintenance treatment of reflux oesophagitis and the treatment of bleeding ulcer. Two studies of patients with duodenal ulcer have shown that maintenance treatment with omeprazole, 10 mg once daily, was as effective as, or superior to, treatment with omeprazole, 20 mg given on Friday, Saturday and Sunday only, and markedly superior to placebo. In patients with gastric ulcer which developed during treatment with NSAIDs omeprazole, 20 mg once daily, resulted in a higher healing rate than ranitidine, 150 mg b.i.d., both at 4 and at 8 weeks. Reflux oesophagitis is often a persistent condition requiring continuous maintenance treatment. In a recent multicentre trial, a substantially higher proportion of patients remained in remission with omeprazole, 20 mg once daily, than with ranitidine, 150 mg b.i.d. Studies comparing omeprazole and ranitidine (administered intravenously) in patients with bleeding peptic ulcers have also demonstrated the superiority of omeprazole with regard to the control of bleeding and the avoidance of surgery. Further studies are currently underway in this and other related areas.

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“…This may be due in part to a mixed population of patients. For instance, in one prospective double-blind study it was found that bleeding from gastric lesions, such as bleeding erosive gastritis or gastric ulcers, was not decreased by cimetidine treatment, while patients with duodenal ulcers and duodenitis had a lesser tendency to rebleeding when cimetidine was administered in conjugation with hourly antacids (51). A few reports suggest that cimetidine is of benefit in patients at high risk of acute upper gastrointestinal bleeding such as those in septic shock, hepatic or respiratory failure, extensive burns, postrenal transplant, or severe trauma (52,53).…”

Section: Cimetidine In the Treatment Of Gastrointestinal Hemorrhagementioning

confidence: 99%