The role of acid suppressants in upper gastrointestinal ulcer bleeding.
Re-bleeding and mortality remain significant in peptic ulcer haemorrhage despite the widespread use of endoscopic therapy. The acidic gastric environment interferes with coagulation. In vitro studies show that an intragastric pH of above 6 results in normal blood coagulation and platelet function. Because of induced tachyphylaxis, H(2)-receptor antagonists are not able to maintain a high pH. In addition, in randomized trials using H(2)-receptor antagonists, there was no reduction in re-bleeding and mortality. High-dose intravenous proton pump inhibitors are capable of maintaining a pH above 6. Four randomized trials, using high-dose intravenous proton pump inhibitors, significantly improved the outcome (in terms of a reduction in re-bleeding and surgery) in patients with peptic ulcer haemorrhage. Mortality was, however, not reduced. The additional effect of acid-suppressant agents after successful endoscopic therapy is limited to the reduction of re-bleeding and need for surgery, with no effect on mortality.
van Leerdam
M E
ME
Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
Rauws
E A
EA
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004064:Digestive System / Q000187:drug effects*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality* / Q000517:prevention & control*; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000627:therapeutic use
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D017494:Proton Pumps