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Thursday, April 19, 2007

Omeprazole before endoscopy beneficial in patients with gastrointestinal bleeding

Omeprazole before endoscopy beneficial in patients with gastrointestinal bleeding

A study published in the New England Journal of Medicine has evaluated the effect of pre-emptive infusion of omeprazole before endoscopy on the need for endoscopic therapy.

Over a 17-month period, consecutive patients admitted with upper GI bleeding were stabilised and then randomised to omeprazole 80-mg IV bolus followed by 8mg/hour infusion (n= 319) or matching placebo (n= 319) before endoscopy the next morning.

The following findings were reported:

  • Need for endoscopic treatment was lower in the omeprazole compared with placebo group (60 of 314 patients included in analysis [19.1%] vs. 90 of 317 patients [28.4%], p = 0.007).
  • There were no significant differences between the omeprazole and placebo group in:
  • mean amount of blood transfused (1.54 and 1.88 units)
  • number of patients who had recurrent bleeding (11 and 8),
  • number who underwent emergency surgery (3 and 4),
  • number who died within 30 days (8 and 7)
  • Hospital stay was < p =" 0.005).">
  • On endoscopy, fewer patients on omeprazole 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).
The study concluded “infusion of high-dose omeprazole before endoscopy accelerated the resolution of signs of bleeding in ulcers and reduced the need for endoscopic therapy.”

N Engl J Med 2007; 356: 1631-40 (link to abstract)

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