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Omeprazole Before Endoscopy Cuts Ulcerative Bleeding

Patients treated with omeprazole tend to leave hospital earlier than those who are not

WEDNESDAY, April 18 (HealthDay News) -- Patients with gastrointestinal bleeding who have a high-dose infusion of the proton-pump inhibitor omeprazole before endoscopy are less likely to have ulcerative bleeding or need endoscopic therapy, according to a report in the April 19 issue of the New England Journal of Medicine.

Neutral pH is critical for clot formation, so the authors hypothesized that omeprazole would have a therapeutic effect on bleeding ulcers. Over a period of 17 months, James Y. Lau, M.D., of The Chinese University in Hong Kong, China, and colleagues enrolled 638 consecutive patients admitted with gastrointestinal bleeding to receive an 80-mg bolus of omeprazole plus 8-mg per hour or placebo until the endoscopic procedure the following morning.

The authors found that 19.1 percent of the omeprazole group needed endoscopic treatment compared with 28.4 percent of the placebo group. More patients in the treatment group were released within three days (60.5 percent vs. 49.2 percent). There were no differences in mean amount of blood transfused, recurrent bleeding, number of emergency surgeries, or 30-day mortality between the two groups.

"We do not propose using high-dose proton-pump inhibitors as a replacement for early endoscopy," the authors wrote. "However, we recommend the preemptive use of high-dose intravenous omeprazole."

Some of the authors had received lecture fees or grant support from AstraZeneca, Pfizer, Takeda, TAP Pharmaceuticals, or GlaxoSmithKline.

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