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Prilosec Helps Control Bleeding in Ulcer Patients

The drug appears to reduce the need for more invasive treatment, study says

WEDNESDAY, April 18, 2007 (HealthDay News) -- Intravenous use of a gastrointestinal drug called a proton pump inhibitor in patients with bleeding ulcers reduced the need for more invasive treatment and resulted in shorter hospital stays.

"In someone presenting with upper gastrointestinal bleeding, acid suppression using proton pump inhibitor should be initiated early and certainly in someone waiting for endoscopy," said study lead author Dr. James Y.W. Lau, of The Chinese University of Hong Kong.

Although treatment with proton pump inhibitors is often initiated before an endoscopy, data on the practice has been lacking.

"We're starting to have the evidence," said Dr. John Pohl, associate professor of pediatrics at the Texas A&M Health Science Center College of Medicine. "This is a good study in a top-tier journal that shows this probably should be looked at as a standardized quality of care in this country as well."

The findings are published in the April 19 issue of the New England Journal of Medicine.

Proton pump inhibitors such as Prilosec (generic name omeprazole) are a class of medications that prevent the release of acid in the stomach and intestines. They are used to treat heartburn, ulcers and other gastrointestinal (GI) problems.

"Proton pump inhibitors have pretty much revolutionized our treatment of ulcer disease," Pohl said.

People with bleeding ulcers often end up in the intensive care unit needing an endoscopy, a procedure that involves sending a long, thin, flexible tube with a miniature TV camera and a light on the end into a person's digestive system. Often, doctors will inject the patients with epinephrine during the procedure to try to stem the bleeding.

"The question is, can you do something ahead of time to make it easier," Pohl said, adding that neutralizing the acid content helps clots to form and bleeding to subside.

For this study, 638 people admitted to a hospital with upper GI bleeding were stabilized and then randomly assigned to receive either Prilosec or a placebo before their endoscopy, scheduled for the next morning.

There were no significant differences between the two groups in the amount of blood transfused or the number of patients who had recurrent bleeding, who underwent emergency surgery or who died within 30 days.

But there were significant differences on other measures.

Only 19.1 percent of people in the Prilosec group needed endoscopic treatment (therapy delivered through the scope), compared to 28.4 percent in the placebo group.

Treatment with Prilosec resulted in earlier hospital discharges: Just over 60 percent of patients in the Prilosec group had a stay of less than three days, compared with 49.2 percent in the placebo group.

And fewer patients in the Prilosec group had actively bleeding ulcers when the scope was inserted. "Bleeding had stopped by the time the endoscopy was performed in those patients receiving omeprazole," Pohl said.

"These patients had less bleeding when they (doctors) took a look, so they had to do less intervention and actually found that the patients got out of the hospital sooner, significantly sooner. So, that's good news," Pohl said.

More studies should be conducted, however, before the approach becomes standard practice, Pohl added.

More information

Visit the American Gastroenterological Association for more on endoscopy.

SOURCES: James Y.W. Lau M.D., The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong; John Pohl, M.D., associate professor of pediatrics, Texas A&M Health Science Center College of Medicine, College Station, and vice chairman of pediatric education in pediatric gastroenterology, Scott & White Hospital; April 19, 2007, New England Journal of Medicine
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