Bleeding peptic ulcer: acute treatment with proton pump inhibitors
DISEASE INTERVENTION COMPARISON RESULTS
BMJ. 1992 Jan 18;304(6820):143-7 Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease The Use of
proton pump inhibitors (PPIs), omeprazole (40 mg/12h)
As Treatment, Acute
Is equal Than
placebo
To reduce recurrent bleeding, need for transfusion, urgent surgery and death.
N Engl J Med. 1997 Apr 10;336(15):1054-8 Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease The Use of
proton pump inhibitors (PPIs), omeprazole (40mg/12h)
As Treatment, Acute
Is better Than
placebo
To reduce persistent or recurrent bleeding (11% omeprazole VS 36% placebo), reduce need for transfusion and urgent surgery.
N Engl J Med. 2007 Apr 19;356(16):1631-40 Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease The Use of
proton pump inhibitors (PPIs), omeprazole (80mg IV before endoscopy)
As Treatment, Acute
Is equal Than
placebo
To reduce recurrent bleeding, transfused blood, emergency endoscopy, emergency surgery or death at 30 days. Omeprazole reduced the need for endoscopic treatment (19% VS 28.4%) and hospital stay (slighty)
Arch Intern Med. 1998 Jan 12;158(1):54-8 Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease, following endoscopic hemostasis The Use of
proton pump inhibitors (PPIs)
As Treatment, Acute
Is better Than
h2-antihistaminics, cimetidine
To reduce recurrent bleeding (4% with omeprazole VS 24% with cimetidine). Transfusion, hsopital stay and mortality were not different.
Am J Gastroenterol. 2006 Mar;101(3):500-5 Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease, following endoscopic hemostasis The Use of
proton pump inhibitors (PPIs), high-dose omeprazole (40 mg/6h IV)
As Treatment, Acute
Is better Than
standard dose omeprazole (40 mg/24h) or cimetidine
To reduce rebleeding (9% high-dose omeprazole VS 33% cimetidine) and reduce blood transfusion. But it did not change: hospital stay, need for urgent operation, and death rate
N Engl J Med. 2000 Aug 3;343(5):310-6 Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic disease, following endoscopic hemostasis The Use of
proton pump inhibitors (PPIs), omeprazole (high-dose IV continuous infusion)
As Treatment, Acute
Is better Than
placebo
To reduce recurrent bleeding (7%) omeprazole VS 22% placebo) There was a non significant trend to reduce surgery and death.
Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002094 Systematic Review, Cochrane Review
IN gastrointestinal bleeding, upper, peptic disease, peptic ulcer The Use of
proton pump inhibitors (PPIs)
As Treatment, Acute
Is better Than
placebo or H(2)-receptor antagonists
To reduce rebleeding (10.6% with PPIs vs 17.3% in controls, OR 0,49) and surgical interventions (6.1% with PPI vs 9.3% in controls, OR 0,61) with no significant effect on mortality (3.8% both)