Omeprazole in treatment of gastrointestinal bleeding - Tips from Other Journals

Date: June, 1992

Approximately 20 percent of patients with acute upper gastrointestinal bleeding require surgery, and the mortality rate is 10 percent. New drugs that inhibit gastric acid secretion by action on the proton pump mechanism could be rapidly effective in patients with hematemesis and melena. Daneshmend and colleagues conducted a double-blind, placebo-controlled trial to evaluate the value of omeprazole, a proton pump inhibitor, in the treatment of acute upper gastrointestinal bleeding.

The study included 1,147 patients admitted to an English hospital during a 40-month period for the treatment of overt gastrointestinal bleeding or acute hematemesis and melena occurring within the preceding 24 hours. Study exclusions included patients who required immediate surgery. A total 578 patients received 80 mg of omeprazole intravenously as soon as possible after admission, followed by three intravenous doses of 40 mg each, with the first dose given between four and 11 hours later and the last two doses given at eight-hour intervals. Treatment with oral omeprazole was continued for at least 101 hours at the discretion of the physician. The remaining 569 patients received placebo.

The two groups were compared in terms of mortality, rate of rebleeding, need for transfusion, occurrence of surgery and endoscopic appearance. Although the treated group showed significant improvement on endoscopic examination, no significant differences were found between the two groups in rates of transfusion, rebleeding, surgery or mortality.

The authors conclude that routine use of acid-inhibiting drugs is not indication the management of acute upper gastrointestinal bleeding. (BMJ, January 18, 1992, vol. 304, p. 143.)

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