CHICAGO — Early high-dose omeprazole infusion speeds resolution of upper gastrointestinal bleeding and reduces the need for endoscopic treatment, according to preliminary results of a prospective trial from Hong Kong.
“Preemptive use of high-dose omeprazole has a hemostatic effect. It hastens resolution of active bleeding, and, in fact, reduces the need for endoscopic therapy,” James Y. Lau, M.D., said at the annual Digestive Disease Week. “It potentially enables early discharge of patients and reduces hospital resource utilization.”
In Dr. Lau's randomized, controlled trial, only 15% of 179 patients treated with omeprazole needed endoscopic therapy, compared with 31% of 190 patients who received placebo.
The study was conducted between February 2004 and November 2004; 648 individuals with upper gastrointestinal bleeding were considered for enrollment in the study. Patients were excluded if they were chronic aspirin users, needed urgent endoscopic therapy, or were considered too unhealthy (such as those with cirrhosis), said Dr. Lau of Prince of Wales Hospital of the Chinese University of Hong Kong.
The treated patients received an 80-mg bolus of intravenous omeprazole, followed by an infusion of 8 mg per hour for 72 hours.
Endoscopy was conducted when it was scheduled in the endoscopy clinic, generally in the morning, after the drug or placebo was begun and the patient had been admitted to the hospital.
Endoscopic treatment was considered necessary when patients were found to still have actively bleeding ulcers or ulcers with nonbleeding but visible vessels, or when there was a clot found that could be lifted to treat an oozing vessel underneath. Treatment consisted of epinephrine injection followed by heater-probe coagulation.
Overall, 220 of the patients were found on endoscopy to have, or to have had, a bleeding gastric ulcer. In that group, 17% of 110 omeprazole-treated patients needed endoscopic treatment, versus 35% of 112 placebo-treated patients. Moreover, only 3 omeprazole-treated patients with a gastric ulcer had active bleeding at the time of endoscopy, compared with 18 of the placebo patients.
Omeprazole appears to help stop bleeding in gastric ulcers because a neutral pH facilitates platelet aggregation, Dr. Lau said.
Dr. Lau's group has previously reported that omeprazole treatment of patients who underwent endoscopic treatment for an upper gastrointestinal bleed significantly decreased the rate of rebleeding within 30 days, from a rate of 22% in a placebo group to 7% in a treated group (N. Engl. J. Med. 2000;343:310–6).