Effect of Intravenous Omeprazole on Recurrent Bleeding after Endoscopic Treatment of Bleeding Peptic Ulcers

Lau, James Y.; Sung, Joseph J.Y.; Lee, Kenneth K. C.; Yung, Man Yee; Wong, SK; Wu, Justin C.Y.; Chan, Francis K.L.; Ng, Enders K.; You, Joyce H. S.; Lee, C. W.; Chan, Angus C.W.; Chung, S. C. S.

doi:10.1056/nejm200008033430501

Cited by 618 publications

(479 citation statements)

References 27 publications

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“…Experience from other countries has been positive: a large study by Lau et al (6) in 2000 included 240 patients randomized to IV omeprazole or placebo following endoscopic therapy. Recurrent bleeding was significantly lower in patients receiving omeprazole (6.7% versus 22.5%), a finding that led to early termination of the trial.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the expected frequencies of endoscopically treatable ulcers and the efficacy of IV PPI from the study by Lau et al (6), significant cost savings can be realized with the use of IV PPI. This model was based on the assumption that all patients received endoscopic examination within 24 h and that only PUD with high-risk stigmata gained benefit from IV PPI.…”

Section: Discussionmentioning

confidence: 99%

“…Prospective, randomized controlled trials have demonstrated efficacy in decreasing rebleeding from high-risk peptic ulcers (defined as active bleeding or presence of a nonbleeding visible vessel) after endoscopic therapy (6).…”

mentioning

confidence: 99%

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

Enns

Andrews

Fishman

et al. 2004

Canadian Journal of Gastroenterology

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BACKGROUND:Intravenous forms of proton pump inhibitors (IV PPI) are routinely used for patients with acute upper gastrointestinal bleeding, but a significant concern for their inappropriate use has been suggested.PATIENTS and METHODS:All consecutive patients who received IV PPI (pantoprazole) over 20 months in six Canadian hospitals were reviewed. Prescribing practices, endoscopic findings and outcomes were recorded.RESULTS:A total of 854 patients received IV PPI. Over 90% of patients were given IV PPI for treatment of known or suspected active upper gastrointestinal bleeding. Most patients (69%) underwent upper endoscopy, and 58% of these patients had peptic ulcer disease (PUD). The majority of patients who had endoscopy (57%) had IV PPI administered in advance of the procedure. Of the 334 patients who had IV PPI given in advance, 46 (13.8%) were found to have high risk bleeding PUD stigmata at endoscopy. The remaining 288 patients (86.2%) with advance IV PPI had low-risk PUD lesions or non-PUD lesions; IV PPI was continued after endoscopy in 164 (56.9%) of these patients.CONCLUSIONS:IV PPI is often used before endoscopy in suspected upper gastrointestinal bleed and maintained, regardless of endoscopic findings, after the endoscopy in many Canadian centres. Further study is required to support these clinical practices.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Enns

Andrews

Fishman

et al. 2004

Canadian Journal of Gastroenterology

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“…Rebleeding rates after successful endoscopic ulcer hemostasis seem to be reduced by at least 5% when high-dose i.v. PPIs rather than histamine-2 receptor antagonists are used, especially if the intragastric pH is maintained above 6 for 48 -72 h (13). In recent studies by Hong Kong investigators, initial hemostasis rates were more than 95% using combination therapy (epinephrine and heater probe) for spurting ulcer bleeding, and rebleeding rates of patients in two randomized, prospective studies treated with i.v.…”

Section: Where Next With Endoscopic Ulcer Hemostasis?mentioning

confidence: 99%

“…Nearly 100% initial hemostasis rates can be achieved and, with high-dose i.v. PPIs for 48 -72 h, rebleeding rates of less than 10% are reported (5,13,14). If these thermal techniques are not available, combination of epinephrine injection and hemoclipping might be considered, with an oblique or side viewing endoscope, if necessary for access to the stigmata.…”

Section: Where Next With Endoscopic Ulcer Hemostasis?mentioning

confidence: 99%

Where next with endoscopic ulcer hemostasis?

Jensen¹

2002

Am J Gastroenterology

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Simple Clinical Predictors May Obviate Urgent Endoscopy in Selected Patients With Nonvariceal Upper Gastrointestinal Tract Bleeding

Romagnuolo

Barkun²,

Enns³

et al. 2007

Arch Intern Med

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Background: The validated Blatchford risk score (BRS) predicts outcomes in patients with nonvariceal upper gastrointestinal tract bleeding, before endoscopy; completion of the Rockall score requires endoscopy. The aims of this study were to predict whether the modified BRS (mBRS) can predict (1) endoscopic high-risk stigmata (HRS) and (2) rebleeding and mortality. Methods: Clinical and demographic characteristics on 1869 patients from 6 Canadian provinces were prospectively entered into the Registry for Upper GI Bleeding and Endoscopy database, recording 30-day rebleeding and mortality. The Rockall score and mBRS (hemoglobin level, hemodynamic instability, and presence of melena, liver disease, or cardiac failure; urea and syncope were not recorded) were calculated. Logistic regression was used to assess the association between an mBRS of 1 or less with HRS and with rebleeding and mortality. Results: The mean (SD) age of the patients was 66 (17) years, with 62% men and a mean of 2.5 comorbidities. Of the 1860 patients with 30-day rebleeding data, 334 (18.0%) rebled; 5.3% died. The mBRS was 0 in 3% and 1 Author Affiliations are listed at the end of this article. Group Information: A list of the members of the Registry for Upper GI Bleeding and Endoscopy Investigator Group appears on page 269.

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Effect of Intravenous Omeprazole on Recurrent Bleeding after Endoscopic Treatment of Bleeding Peptic Ulcers

Cited by 618 publications

References 27 publications

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

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

Where next with endoscopic ulcer hemostasis?

Simple Clinical Predictors May Obviate Urgent Endoscopy in Selected Patients With Nonvariceal Upper Gastrointestinal Tract Bleeding

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