Effects of different omeprazole dosing on gastric pH in non‐variceal upper gastrointestinal bleeding: A randomized prospective study

Chwiesko, Adam; Charkiewicz, Radosław; Nikliński, Jacek; Łuczaj, Wojciech; Skrzydlewska, Elżbieta; Milewski, Robert; Baniukiewicz, Andrzej; Wróblewski, Eugeniusz; Rosołowski, Mariusz; Dâbrowski, A

doi:10.1111/1751-2980.12393

Cited by 4 publications

(4 citation statements)

References 26 publications

(55 reference statements)

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“…Our non-significant findings ( p > 0.05) with CYP2C19*17 alleles are consistent with a randomized prospective study on 50 samples with non-variceal upper-gastrointestinal bleeding ( Chwiesko et al, 2016 ). The subjects were randomized to either 40 mg intravenous omeprazole bolus injection every 12 h or 8 mg/h continuous intravenous infusion for 72 h after an 80 mg intravenous omeprazole bolus dose.…”

Section: Discussionsupporting

confidence: 91%

“…The subjects were randomized to either 40 mg intravenous omeprazole bolus injection every 12 h or 8 mg/h continuous intravenous infusion for 72 h after an 80 mg intravenous omeprazole bolus dose. Genotyping and measuring the percentage of time with pH values >4.0 and >6.0 at several time points showed no significant association between CYP2C19 RM + UM and intragastric pH in both groups ( Chwiesko et al, 2016 ).…”

Section: Discussionmentioning

confidence: 95%

“…Despite the extensive literature on the impact of CYP2C19 genotypes on omeprazole pharmacokinetics, studies investigating the clinical efficacy of omeprazole with CYP2C19 rapid metabolizers (RMs) (*1/*17) and UMs (*17/*17) remain limited and were mostly carried out in non-GERD samples ( Arévalo Galvis et al, 2019 ; Chwiesko et al, 2016 ; Molina-Infante et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

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Omeprazole Treatment Failure in Gastroesophageal Reflux Disease and Genetic Variation at the CYP2C Locus

et al. 2022

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Omeprazole is extensively used to manage gastroesophageal reflux disease (GERD). It is primarily metabolized by CYP2C19. The CYP2C19*17 (rs12248560) allele and the recently described CYP2C:TG haplotype (rs11188059 and rs2860840) are associated with increased enzymatic activity, and may reduce omeprazole exposure. This observational study aimed to investigate the association between these genetic variants and omeprazole treatment failure in GERD. We recruited predominantly New Zealand European GERD patients who either did not respond to omeprazole or experienced breakthrough heartburn symptoms despite at least 8 weeks of omeprazole (≥40 mg/day). The GerdQ score was used to gauge symptomatic severity. A total of 55 cases were recruited with a median age (range) of 56 years (19–82) and GerdQ score of 11 (5–17). Of these, 19 (34.5%) were CYP2C19*17 heterozygotes and two (3.6%) were CYP2C19*17 homozygotes. A total of 30 (27.3%) CYP2C:TG haplotypes was identified in our cohort, with seven (12.7%) CYP2C:TG homozygotes, and 16 (29%) CYP2C:TG heterozygotes. No significant differences were observed for overall CYP2C19*17 alleles, CYP2C19*17/*17, overall CYP2C:TG haplotypes, and CYP2C:TG heterozygotes (p > 0.05 for all comparisons). Gastroscopy and 24-h esophageal pH/impedance tests demonstrated objective evidence of GERD in a subgroup of 39 (71%) cases, in which the CYP2C:TG/TG was significantly enriched (p = 0.03) when compared with the haplotype frequencies in a predominantly (91%) New Zealand European reference population, but not the CYP2C19*17/*17 (p > 0.99), when compared with the allele frequencies for the non-Finnish European subset of gnomAD. We conclude that omeprazole treatment failure in GERD is associated with CYP2C:TG/TG, but not CYP2C19*17.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Omeprazole Treatment Failure in Gastroesophageal Reflux Disease and Genetic Variation at the CYP2C Locus

et al. 2022

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“…Thus, we improved the conventional treatment so that patients were administered PPI through continuous intravenous injection (80 mg qd) within 3-7 days after surgery, and PPI withdrawal was initiated when the hemodynamics of patients were stable after extubation and they could eat normally or be fed with enteral nutrition through a nasogastric tube without gastrointestinal symptoms such as abdominal pain, ventosity or dysphoria. The pH value of gastric mucosa could be continuously maintained above 6.0 with this modified antacid strategy without rebounding during the interval of bolus administration of PPI [Chwiesko 2016].…”

Section: Discussionmentioning

confidence: 99%

The Prophylactic Effect of Proton Pump Inhibitors Combined with Enteral Nutrition for Preventing Gastrointestinal Hemorrhage after Cardiovascular Surgery in High-Risk Patients

Chen

Lin

2019

HSF

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Background: Gastrointestinal hemorrhage (GH) is one of the most serious complications after cardiovascular surgery. The aim of the study was to provide an optimal therapeutic strategy for preventing postoperative GH in high-risk patients. Methods: This retrospective case-control study included 188 adult patients at high risk of postoperative GH. These patients were divided into two groups based on a strategy for preventing postoperative GH: Group A (n = 97) received continuous intravenous infusion of proton-pump inhibitor (PPI) combined with early enteral nutrition, and Group B (n = 91) received a bolus intravenous infusion of PPI combined with late enteral nutrition. The clinical features of the groups were examined. Results: The incidence of postoperative GH in the patients of group A was significantly lower than the patients in group B. The duration from the end of surgery to eating for the first time in the patients of group A was significantly shorter than in the patients of group B. A descending trend in 30-day mortality was observed in the patients of group A compared with group B, but no significant difference was found between the two groups. Conclusion: Continuous intravenous infusion of PPI combined with early enteral nutrition could effectively prevent GH and reduce 30-day mortality after cardiovascular surgery in high-risk patients.

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Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding

Kanno

Yuan

Tse

et al. 2022

Cochrane Database of Systematic Reviews

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Effects of different omeprazole dosing on gastric pH in non‐variceal upper gastrointestinal bleeding: A randomized prospective study

Abstract: In patients with NVUGIB, OME i.v. bolus followed by continuous infusion is more effective than OME i.v. bolus every 12 h in maintaining higher intragastric pH, regardless of CYP2C19 genetic polymorphisms. H. pylori infection accelerates the initial elevation of intragastric pH.

Cited by 4 publications

References 26 publications

Omeprazole Treatment Failure in Gastroesophageal Reflux Disease and Genetic Variation at the CYP2C Locus

Omeprazole Treatment Failure in Gastroesophageal Reflux Disease and Genetic Variation at the CYP2C Locus

The Prophylactic Effect of Proton Pump Inhibitors Combined with Enteral Nutrition for Preventing Gastrointestinal Hemorrhage after Cardiovascular Surgery in High-Risk Patients

Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding

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