Proton-pump inhibitors for acute peptic ulcer bleeding.
OBJECTIVE
To review the use of proton-pump inhibitors for acute peptic ulcer bleeding.


METHODS
Articles were obtained through computerized searches of MEDLINE (1966-September 2000). Additionally, several textbooks containing information on the diagnosis and management of acute peptic ulcer bleeding were reviewed. The bibliographies of retrieved publications and textbooks were reviewed for additional references.


METHODS
All randomized studies and pharmacoeconomic evaluations that used proton-pump inhibitor therapy for acute peptic ulcer bleeding were included. Randomized controlled trials and meta-analyses involving other therapies for treating peptic ulcer bleeding were also reviewed for possible inclusion.


METHODS
The primary outcomes extracted from the literature were persistent or recurrent bleeding, transfusion requirements, need for endoscopic intervention or surgery, length of stay, and mortality.


RESULTS
Data from double-blind, placebo-controlled trials involving more than 1000 patients demonstrate that short-term, high-dose omeprazole therapy is effective for reducing bleeding and transfusion requirements in patients with acute peptic ulcer bleeding. The patients most likely to benefit from this therapy are hospitalized patients at high risk for rebleeding and patients in whom endoscopic evaluation must be delayed or is unavailable.


CONCLUSIONS
Omeprazole (and likely other proton-pump inhibitors) is useful in reducing bleeding and transfusion requirements in patients with acute peptic ulcer bleeding, although better delineation of appropriate candidates is needed.
Erstad
B L
BL
Department of Pharmacy Practice & Science, College of Pharmacy, 1703 E. Mabel St., Tucson, AZ 85721-0207, USA. erstad@pharmacy.arizona.edu
D000208:Acute Disease; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D009853:Omeprazole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000150:complications*; D054328:Proton Pump Inhibitors; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D009853:Omeprazole