Utility of proton pump inhibitors in the treatment of gastrointestinal hemorrhage.
Proton pump inhibitors inhibit gastric acid secretion thereby promoting the healing of peptic ulcers and decreasing the occurrence of gastrointestinal bleeding. An intravenous formulation of the PPI pantoprazole is now available in the United States. Some clinicians have prescribed this product after endoscopic hemostasis of acute upper gastrointestinal hemorrhage to prevent recurrence. Historically, the evidence is weak for the use of histamine H2-receptor antagonists in this role. Fifteen original studies on the use of intravenous proton pump inhibitors in this setting are reviewed. The evidence for their efficacy is similarly weak and does not justify the increased cost of their use in this setting. Larger, more definitive studies on proton pump inhibitors are needed to clarify their role in the control of acute upper gastrointestinal hemorrhage.
Martin
Ralph A
RA
University of Connecticut School of Medicine, Department of Medicine, Saint Francis Hospital and Medical Center, Hartford, USA. RMartin@stfranciscare.org
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001562:Benzimidazoles / Q000191:economics / Q000627:therapeutic use*; D003237:Connecticut; D003362:Cost-Benefit Analysis; D004791:Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use*; D005572:Formularies, Hospital as Topic; D005744:Gastric Acid / Q000378:metabolism; D005773:Gastroscopy; D006635:Histamine H2 Antagonists / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D009853:Omeprazole / Q000031:analogs & derivatives; D000077402:Pantoprazole; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D010606:Pharmacy and Therapeutics Committee; D054328:Proton Pump Inhibitors; D013454:Sulfoxides / Q000191:economics / Q000627:therapeutic use*
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001562:Benzimidazoles; D004791:Enzyme Inhibitors; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D013454:Sulfoxides; D000077402:Pantoprazole; D009853:Omeprazole