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Article: Omeprazole before endoscopy in patients with gastrointestinal bleeding

TitleOmeprazole before endoscopy in patients with gastrointestinal bleeding
Authors
Issue Date2007
PublisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/
Citation
New England Journal Of Medicine, 2007, v. 356 n. 16, p. 1631-1640 How to Cite?
Abstract
Background: A neutral gastric pH is critical for the stability of clots over bleeding arteries. We investigated the effect of preemptive infusion of omeprazole before endoscopy on the need for endoscopic therapy. Methods: Consecutive patients admitted with upper gastrointestinal bleeding underwent stabilization and were then randomly assigned to receive either omeprazole or placebo (each as an 80-mg intravenous bolus followed by an 8-mg infusion per hour) before endoscopy the next morning. Results: Over a 17-month period, 638 patients were enrolled and randomly assigned to omeprazole or placebo (319 in each group). The need for endoscopic treatment was lower in the omeprazole group than in the placebo group (60 of the 314 patients included in the analysis [19.1%] vs. 90 of 317 patients [28.4%], P=0.007). There were no significant differences between the omeprazole group and the placebo group in the mean amount of blood transfused (1.54 and 1.88 units, respectively; P=0.12) or the number of patients who had recurrent bleeding (11 and 8, P=0.49), who underwent emergency surgery (3 and 4, P=1.00), or who died within 30 days (8 and 7, P=0.78). 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 (P=0.005). On endoscopy, fewer patients in the omeprazole group had actively bleeding ulcers (12 of 187, vs. 28 of 190 in the placebo group; P=0.01) and more omeprazole-treated patients had ulcers with clean bases (120 vs. 90, P=0.001). Conclusions: Infusion of high-dose omeprazole before endoscopy accelerated the resolution of signs of bleeding in ulcers and reduced the need for endoscopic therapy. Copyright © 2007 Massachusetts Medical Society.
Persistent Identifierhttp://hdl.handle.net/10722/163071
ISSN
2013 Impact Factor: 54.420
ISI Accession Number ID
References

 

Author Affiliations
  1. Prince of Wales Hospital Hong Kong
  2. Chinese University of Hong Kong
DC FieldValueLanguage
dc.contributor.authorLau, JYen_US
dc.contributor.authorLeung, WKen_US
dc.contributor.authorWu, JCYen_US
dc.contributor.authorChan, FKLen_US
dc.contributor.authorWong, VWSen_US
dc.contributor.authorChiu, PWYen_US
dc.contributor.authorLee, VWYen_US
dc.contributor.authorLee, KKCen_US
dc.contributor.authorCheung, FKYen_US
dc.contributor.authorSiu, Pen_US
dc.contributor.authorNg, EKWen_US
dc.contributor.authorSung, JJYen_US
dc.date.accessioned2012-09-05T05:27:14Z-
dc.date.available2012-09-05T05:27:14Z-
dc.date.issued2007en_US
dc.identifier.citationNew England Journal Of Medicine, 2007, v. 356 n. 16, p. 1631-1640en_US
dc.identifier.issn0028-4793en_US
dc.identifier.urihttp://hdl.handle.net/10722/163071-
dc.description.abstractBackground: A neutral gastric pH is critical for the stability of clots over bleeding arteries. We investigated the effect of preemptive infusion of omeprazole before endoscopy on the need for endoscopic therapy. Methods: Consecutive patients admitted with upper gastrointestinal bleeding underwent stabilization and were then randomly assigned to receive either omeprazole or placebo (each as an 80-mg intravenous bolus followed by an 8-mg infusion per hour) before endoscopy the next morning. Results: Over a 17-month period, 638 patients were enrolled and randomly assigned to omeprazole or placebo (319 in each group). The need for endoscopic treatment was lower in the omeprazole group than in the placebo group (60 of the 314 patients included in the analysis [19.1%] vs. 90 of 317 patients [28.4%], P=0.007). There were no significant differences between the omeprazole group and the placebo group in the mean amount of blood transfused (1.54 and 1.88 units, respectively; P=0.12) or the number of patients who had recurrent bleeding (11 and 8, P=0.49), who underwent emergency surgery (3 and 4, P=1.00), or who died within 30 days (8 and 7, P=0.78). 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 (P=0.005). On endoscopy, fewer patients in the omeprazole group had actively bleeding ulcers (12 of 187, vs. 28 of 190 in the placebo group; P=0.01) and more omeprazole-treated patients had ulcers with clean bases (120 vs. 90, P=0.001). Conclusions: Infusion of high-dose omeprazole before endoscopy accelerated the resolution of signs of bleeding in ulcers and reduced the need for endoscopic therapy. Copyright © 2007 Massachusetts Medical Society.en_US
dc.languageengen_US
dc.publisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/en_US
dc.relation.ispartofNew England Journal of Medicineen_US
dc.titleOmeprazole before endoscopy in patients with gastrointestinal bleedingen_US
dc.typeArticleen_US
dc.identifier.emailLeung, WK:waikleung@hku.hken_US
dc.identifier.authorityLeung, WK=rp01479en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1056/NEJMoa065703en_US
dc.identifier.pmid17442905-
dc.identifier.scopuseid_2-s2.0-34247260475en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-34247260475&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume356en_US
dc.identifier.issue16en_US
dc.identifier.spage1631en_US
dc.identifier.epage1640en_US
dc.identifier.eissn1533-4406-
dc.identifier.isiWOS:000245762000005-
dc.publisher.placeUnited Statesen_US
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dc.identifier.scopusauthoridLau, JY=34667994100en_US
dc.identifier.scopusauthoridLeung, WK=7201504523en_US
dc.identifier.scopusauthoridWu, JCY=7409253910en_US
dc.identifier.scopusauthoridChan, FKL=7202586434en_US
dc.identifier.scopusauthoridWong, VWS=7202525502en_US
dc.identifier.scopusauthoridChiu, PWY=7103182534en_US
dc.identifier.scopusauthoridLee, VWY=7402507380en_US
dc.identifier.scopusauthoridLee, KKC=7501515004en_US
dc.identifier.scopusauthoridCheung, FKY=7102329452en_US
dc.identifier.scopusauthoridSiu, P=16234566300en_US
dc.identifier.scopusauthoridNg, EKW=7201647539en_US
dc.identifier.scopusauthoridSung, JJY=35405352400en_US

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