Omeprazole before endoscopy in patients with gastrointestinal bleeding.
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. (ClinicalTrials.gov number, NCT00164866 [ClinicalTrials.gov] .).
Lau
James Y
JY
Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, China. laujyw@surgery.cuhk.edu.hk
Leung
Wai K
WK
Wu
Justin C Y
JC
Chan
Francis K L
FK
Wong
Vincent W S
VW
Chiu
Philip W Y
PW
Lee
Vivian W Y
VW
Lee
Kenneth K C
KK
Cheung
Frances K Y
FK
Siu
Priscilla
P
Ng
Enders K W
EK
Sung
Joseph J Y
JJ
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001803:Blood Transfusion; D004311:Double-Blind Method; D004724:Endoscopy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000517:prevention & control; D011292:Premedication; D055502:Secondary Prevention
D000897:Anti-Ulcer Agents; D009853:Omeprazole