Critical Review of Acid Suppression in Nonvariceal, Acute, Upper Gastrointestinal Bleeding

Abstract

Nonvariceal, upper gastrointestinal (GI) bleeding is a very common source of morbidity and mortality. The concept of ulcer clot dissolution being facilitated by a low gastric pH has allowed us to better understand the pathophysiology of nonvariceal upper GI bleeding. Placebo-controlled trials have shown the benefit of oral proton pump inhibitor administration in contrast to H₂ receptor antagonists. Furthermore, our recent experience with intravenous proton pump inhibitors has reinforced these observations.

A prospective randomized trial of either famotidine or omeprazole for the prevention of bleeding after endoscopic mucosal resection and the healing of endoscopic mucosal resection‐induced ulceration

“…Several randomized‐controlled trials on the effectiveness of the two drugs for preventing rebleeding after endoscopic haemostasis of haemorrhagic peptic ulcers are controversial: some reports state that PPIs are better 15 and others state that both treatments are the same 16 . Gastric pH affects blood coagulation and platelet aggregation at the site of bleeding 17 . It has been reported that pepsin is active below pH 5.0 and accelerate clot digestion 18 .…”

High‐dose intravenous proton pump inhibition following endoscopic therapy in the acute management of patients with bleeding peptic ulcers in the USA and Canada: a cost‐effectiveness analysis

“…Based on the literature search of randomized trials and published reviews, [4][5][6][7][16][17][18][19][20][21][22][23][24][25][26] only two randomized studies fulfilled the pre-set selection criteria. 4,7 Others either did not allow for a precise estimate of the probability of re-bleeding 5,6 or included patients who did not have high-risk ulcer lesions.…”

Cost Implications of Administering Intravenous Proton Pump Inhibitors to All Patients Presenting to the Emergency Department with Peptic Ulcer Bleeding

“…However, not all types of acid‐suppressive therapy have similar efficacy profiles. There is general agreement that proton pump inhibitors (PPI), e.g., pantoprazole and omeprazole, are more effective than H 2 ‐receptor antagonists for the treatment and prevention of UGI bleeding from severe gastric‐acid‐related disorders [1–4]. High‐dose parenteral PPIs have also recently been introduced to provide rapid acid suppression when the patient's medical condition precludes giving oral formulations [1].…”