Prospective randomized trial for optimal prophylactic treatment of the upper gastrointestinal complications after open heart surgery.
BACKGROUND
Upper gastrointestinal bleeding is a lethal complication after open heart surgery. We designed a prospective randomized trial to test the efficacy of different antisecretory agents to prevent upper gastrointestinal disease after operation.


RESULTS
A total of 210 patients were divided into 3 groups: group I had 70 patients who had mucosal protection (teprenone 150 mg/day), group II had 70 patients who had histamine2-receptor antagonist (ranitidine 300 mg/day), and group III included 70 patients who had a proton pump inhibitor (rabeprazole 10 mg/day). Gastric fiberscopy was used in all patients postoperatively during days 5 to 7. We compared the 3 groups in terms of endoscopic findings. Four patients (5.7%) had gastric bleeding complications in each of groups I and II; 2 died of coagulopathy. In group III no patients had gastric bleeding. The incidence of hemorrhagic gastritis was significantly higher in groups I (22.9%) and II (15.7%) than in III (2.9%) (p=0.0003). The incidence of active ulcers was also significantly higher in groups I (28.6%) and II (21.4%) than in III (4.3%) (p=0.0001).


CONCLUSIONS
Early medication postoperative by a proton pump inhibitor was shown to be the most effective treatment and indeed might be described as mandatory to prevent upper gastrointestinal diseases after open heart surgery.
Hata
Mitsumasa
M
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. mihata@med.nihon-u.ac.jp
Shiono
Motomi
M
Sekino
Hisakuni
H
Furukawa
Hidekazu
H
Sezai
Akira
A
Iida
Mitsuru
M
Yoshitake
Isamu
I
Hattori
Tsutomu
T
Wakui
Sinji
S
Soeda
Masao
M
Taoka
Makoto
M
Negishi
Nanao
N
Sezai
Yukiyasu
Y
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D001562:Benzimidazoles / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004224:Diterpenes / Q000008:administration & dosage; D016099:Endoscopy, Gastrointestinal; D005756:Gastritis / Q000209:etiology / Q000517:prevention & control; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006635:Histamine H2 Antagonists / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control*; D011292:Premedication / Q000379:methods*; D006180:Proton-Translocating ATPases / Q000037:antagonists & inhibitors; D064750:Rabeprazole; D011899:Ranitidine / Q000008:administration & dosage; D014456:Ulcer / Q000209:etiology / Q000517:prevention & control; D041742:Upper Gastrointestinal Tract
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D004224:Diterpenes; D006635:Histamine H2 Antagonists; D064750:Rabeprazole; D011899:Ranitidine; D006180:Proton-Translocating ATPases; D009853:Omeprazole; C031049:geranylgeranylacetone