PPI (Proton pump inhibitor) drip !
One notable study recently published in The New England Journal of Medicine regarding use of preemptive Omeprazole (PPI) infusion - 80 mg IV bolus followed by an 8 mg per hour drip - before Endoscopy in Patients with Gastrointestinal Bleeding. The basic concept is a neutral gastric PH is critical for the stability of clots over bleeding arteries.
638 patients were enrolled and randomly assigned to omeprazole or placebo (319 in each group).
Patients with hypotensive shock had been first stabilized. Patients requiring urgent endoscopy or surgery were excluded. Long term aspirin users were excluded. For nonsteroidal antiinflammatory drugs users, the drugs were discontinued. Patients who had bleeding from coumadin were given vitamin K or FFP. - See full article for inclusion or exclusion criteria.
Results:
- The need for endoscopic treatment was lower in the omeprazole group than in the placebo group ( 19.1% vs. 28.4%).
- The hospital stay was less than 3 days in 60.5% of patients in the omeprazole group, as compared with 49.2% in the placebo group.
- On endoscopy, fewer patients in the omeprazole group had actively bleeding ulcers (12 of 187, vs. 28 of 190 in the placebo group) and
- more omeprazole-treated patients had ulcers with clean bases (120 vs. 90).
But there were no significant differences in the mean amount of blood transfused, the number of patients who had recurrent bleeding, who underwent emergency surgery or who died within 30 days.
Authors concluded that Infusion of high-dose omeprazole before endoscopy accelerated the resolution of signs of bleeding in ulcers and reduced the need for endoscopic therapy.
Reference: click to get article/abstract
1. Omeprazole before Endoscopy in Patients with Gastrointestinal Bleeding -, NEJM, April 19, 2007, Volume 356:1631-1640
