Non-Bleeding Visible Vessel Treatment: Perendoscopic Injection Therapy versus Omeprazole Infusion

Grosso, C.; Rossi, Alfredo; Gambitta, P.; Bini, Marta; Zanasi, G.; Pirone, Z.; Arcidiacono, R

doi:10.3109/00365529509101593

Cited by 34 publications

(22 citation statements)

References 8 publications

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“…The frequency of rebleeding from nonbleeding visible vessels in patients undergoing "standard medical therapy" (i.e., intravenous H 2 -receptor antagonists and later oral proton pump inhibitors) ranges from 40 to 50%, with 95% confidence intervals from pooled data ranging from 27 to 52% (1,36,38). As previously mentioned, Khuroo et al showed in a post hoc subgroup analysis that 40 mg of oral omeprazole twice daily alone reduced the rebleeding rate of ulcers with nonbleeding visible vessels to 11.8% (20), which is comparable to the rebleeding rate of 17 to 19% achieved by endoscopy alone (39,40). Grosso et al directly compared the two therapies in 42 patients with nonbleeding visible vessels in peptic ulcers randomized to endoscopic injection therapy and standard medical therapy (which included intermittent intravenous ranitidine) or intravenous omeprazole (40 mg twice daily for 2 days) followed by oral omeprazole at 40 mg daily (40).…”

Section: Discussionmentioning

confidence: 50%

“…As previously mentioned, Khuroo et al showed in a post hoc subgroup analysis that 40 mg of oral omeprazole twice daily alone reduced the rebleeding rate of ulcers with nonbleeding visible vessels to 11.8% (20), which is comparable to the rebleeding rate of 17 to 19% achieved by endoscopy alone (39,40). Grosso et al directly compared the two therapies in 42 patients with nonbleeding visible vessels in peptic ulcers randomized to endoscopic injection therapy and standard medical therapy (which included intermittent intravenous ranitidine) or intravenous omeprazole (40 mg twice daily for 2 days) followed by oral omeprazole at 40 mg daily (40). The rebleeding rate at 48 hr was 19% in both groups.…”

Section: Discussionmentioning

confidence: 51%

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Appropriate Use of Intravenous Proton Pump Inhibitors in the Management of Bleeding Peptic Ulcer

Julapalli

Graham

2005

Dig Dis Sci

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Rebleeding from peptic ulcers is a major unsolved problem in the management of acute upper gastrointestinal bleeding. Our goal was to review what is known and what remains to be learned about the effectiveness of antisecretory therapy for acute upper gastrointestinal bleeding. We reviewed the data regarding the effectiveness of endoscopic therapy, the prediction of those at increased risk for rebleeding, and the effectiveness of antisecretory drug therapy in preventing rebleeding with or without endoscopic hemostasis. Proton pump inhibitor therapy without endoscopic hemostasis is ineffective clinically for stopping bleeding or preventing rebleeding. Endoscopic hemostasis remains the cornerstone of therapy. The data are consistent with the notion that reliable maintenance of the intragastric pH at > or = 6 after endoscopic hemostasis is associated with the lowest rebleeding rates. H2-receptor antagonists are ineffective for achieving this goal. Intermittent bolus and oral administration of proton pump inhibitors are equivalent and fail to achieve this goal, which can only be accomplished by bolus administration of a proton pump inhibitor (e.g., 80 mg) followed by a constant infusion (e.g., 8 mg/hr). Whether the combination of endoscopic hemostasis and pH control is equal or superior to selected second-look endoscopy is unknown. A treatment algorithm is suggested.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 51%

Appropriate Use of Intravenous Proton Pump Inhibitors in the Management of Bleeding Peptic Ulcer

Julapalli

Graham

2005

Dig Dis Sci

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“…Grosso et al [63] conducted a European RCT of 42 similar, the 3-week mortality rate in the OME group was comparable to that seen in other studies but was patients with a history of acute bleed and nonbleeding visible vessel and endoscopy within 3 h (endoscopic treat-significantly greater than the unexpectedly low mortality rate seen in the placebo group [65]. Mortality rates in the ment group only).…”

Section: Role Of Ppi Therapy For Ugibmentioning

confidence: 68%

“…[54]. However, as with all retrospective analyses, the results of this study should be interpreted with caution, as Finally, a small randomized trial compared IV OME to endoscopic treatment plus IV RAN, and no significant the different patient groups may not be entirely comparable with regard to clinical characteristics that might differences were noted, but the trial was small and lacked statistical power [63]. affect outcomes of bleeding.…”

Section: Role Of Ppi Therapy For Ugibmentioning

confidence: 98%

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

Yacyshyn

Thomson²

2000

Dig Dis

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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.

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“…By contrast, some studies disagree with the primary use of endoscopy in cases with visible vessels or adherent blood clots. Among the pharmacologic agents, administration of PPIs only had an effect comparable to that of endoscopic therapy [13,14].…”

Section: Introductionmentioning

confidence: 96%

Oral Proton Pump Inhibitors Are as Effective as Endoscopic Treatment for Bleeding Peptic Ulcer: A Prospective, Randomized, Controlled Trial

et al. 2007

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In managing patients with bleeding peptic ulcers, it has been reported that pharmacologic treatment can be an alternative to endoscopic treatment. We compared the hemostasis rates of the endoscopic treatment, hemoclipping, and the pharmacologic treatment, oral proton pump inhibitors (PPIs), in bleeding peptic ulcer. A randomized prospective study was performed on 129 bleeding peptic ulcer patients with hematemesis or melena. Sixty-two patients were treated by endoscopic hemoclipping and subsequently H(2) receptor antagonists were injected intravenously (hemoclipping group), and 67 patients were treated with an oral PPI without endoscopic treatment (PPI group). The 24-hr gastric pH test was performed sequentially following the treatment. The initial hemostasis rate of the hemoclipping group was 93.5% (58/62) and the rebleeding rate was 6.9% (4/58), and the hemostasis rate of the PPI group was 92.5% (62/67) and the rebleeding rate was 7.5% (5/67), which were not different. The 24-hr gastric pH was 4.54+/-2.56 in the hemoclipping group and 5.97+/-1.30 in the PPI group (P<0.037). In the bleeding peptic ulcer patients, the hemostasis rate with the oral administration of PPIs was not different from that with the endoscopic hemoclipping treatment.

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Non-Bleeding Visible Vessel Treatment: Perendoscopic Injection Therapy versus Omeprazole Infusion

Abstract: Our data suggest that omeprazole infusion is a valid alternative to injection treatment of non-bleeding visible vessels.

Cited by 34 publications

References 8 publications

Appropriate Use of Intravenous Proton Pump Inhibitors in the Management of Bleeding Peptic Ulcer

Appropriate Use of Intravenous Proton Pump Inhibitors in the Management of Bleeding Peptic Ulcer

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

Oral Proton Pump Inhibitors Are as Effective as Endoscopic Treatment for Bleeding Peptic Ulcer: A Prospective, Randomized, Controlled Trial

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