06Mar 2019

OUTCOME OF ORAL VS. INTRAVENOUS ESOMEPRAZOLE IN BLEEDING PEPTIC ULCER (SRH+) AFTER ENDOSCOPIC TREATMENT.

  • Resident, Department of Gatroenterology , Sher-i- Kashmir Institute of Medical sciences.
  • Professor, Department of Gatroenterology , Sher-i- Kashmir Institute of Medical sciences.
Crossref Cited-by Linking logo

  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Context: Peptic ulcer disease is the most common cause of upper gastrointestinal bleed and a common problem in the emergency department. Approximately a third of the patients with significant ulcer bleeding will develop recurrent bleeding on long-term follow-up, in the absence of active intervention . Although endoscopic hemostasis reduces mortality, acid suppression not only helps in achieving hemostasis but also reduces rebleeding . Aims: To study the outcome of Oral vs. Intravenous esomeprazole in bleeding peptic ulcer (SRH+) after endoscopic treatment in terms of rebleeding and in increasing the intraluminal pH . Materials and Methods: About 200 patients with upper gastrointestinal bleeding presenting with malena or hemetemesis or both were enrolled for the study. After endoscopic hemostasis , patients were randomized into two groups; one receiving oral esmoprazole and the other receiving intravenous (IV) esmoprazole. The primary end points were rate of rebleeding and secondary end points were surgery; number of deaths, duration of hospital stay, number of blood transfusions and number of rescue therapies required. The intragastric pH study was done in 20 patients; 10 patients on oral esomeprazole and 10 on IV esomeprazole. Results: The baseline characterstitics of patients including age, sex, previous peptic ulcer disease, concurrent illness, the severity of bleeding at presentation, sight and size of ulcer, use of NSAIDS and endoscopic findings were comparable in the two groups. Rebleeding occured in 25 patients (12.5%); 14 patients (13.86%) in oral group and 11 patients (11.11%) in IV group. Emergency surgery was required in 7 (6%) patients in oral esomeprazole group as compared to 5(5%) patients in esomeprazole group. The mean number of patients who received blood transfusion were 9 (8.9%) in oral esomeprazole group and 11 (11.11%) in IV esomeprazole group. The total duration of hospital stay in oral group was 3.60+1.72 vs. 3.47+1.30 in IV group. The mean 72 hrs. intragastric pH in oral esomeprazole group was 7.06+0.44 and 6.78+0.27 in IV esomeprazole group. Conclusions: Both oral and intravenous esomeprazole given to patients of bleeding peptic ulcers with SRH after endoscopic hemostasis had a similar effect on both the primary and secondary end points.

  1. Gilbert DA. (1990). Epidemiology of upper gastrointestinal bleeding. Gastrointest Endosc., 36: S8-13.
  2. Laine L, Peterson WL. (1994) Bleeding peptic Ulcer. N. Engl. J. Med., 331 :717-25.
  3. Kurata JH. (1984). Epidemiology of peptic ulcer disease. Clin Gastroenterol., 13:289.
  4. Peterson, WL, Barnett, CC & Smith, HJ et al. (1981) Routine early endoscopy in upper-gastrointestinal-tract bleeding: a randomized, controlled trial. N Engl J ,304: 925-9.
  5. Sacks, HS, Chalmers, TC & Blum, AL et al. (1990) Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. ,264: 494-9.
  6. Lee, JG, Turnipseed, S & Romano, PS et al. (1999) Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest , 50:755-61.
  7. Jensen DM.(1999) Spots and clots ? leave them or treat them? Why and how to treat. Can J Gastroenterol., 13: 1307-11.
  8. Cook, DJ, Guyatt. GH & Salena, BJ et al.(1992) Endoscopic therapy for acute non variceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology., 102:139-48.
  9. Lau, JY, Sung, JJ & Chan, AC et al. (1997) Stigmata of hemorrhage in bleeding peptic ulcers: an interobserver agreement study among international experts. Gastrointest Endosc ., 46: 33-6.
  10. Laine, L, Freeman, M & Cohen, H. (1994) Lack of uniformity in evaluation of endoscopic prognostic features of bleeding ulcers. Gastrointest Endosc.,40:411-7.
  11. Leontiadis GI, Meintyre L,? Sharma YK, Howden CW.(2004) Proton pump inhibitor treatment for acute peptic ulcer bleeding (Cochrane Review)., 3:ACD002094.
  12. Schaffahtzky de Muckadell OB, Havelund T, Harling H et al. (1997) Effect of omeprazole on the outcome of endoscopically treated bleeding peptic ulcers. Randomized double blind placebo controlled multicenter study. Scand J Gastroenterol., 32:320-327.
  13. Zed PJ, Loewen PS, Slavik RS, Maera CA. (2001) Metaanalysisis of proton pump inhibitors in treatment of bleeding peptic ulcers. Ann Pharmacother., 35:1528-34.
  14. Labenz J, Peitz U, Leusing C, Tillenburg B, Blum AL, Borsch G. (1997) Efficacy of primed infusions with high dose ranitidine and omeprazole to maintain high intragastric pH in patients with peptic ulcer bleeding, a prospective randomised controlled study. Gut., 40:36-41.
  15. Barnert J, Bittinger M, Wienbeck M. (1994) Effects of intravenous infusion of omeprazole and ranitidine on intragastric acidity in bleeding peptic ulcer patients. Gastroenterology., 106:A46.
  16. Kiilerich S, Rannelll T, Elsborg L. (1995) Effect of intravenous in fusion of omeprazole and ranitidine on 24 hour intragastric pH in patients with a history of duodenal ulcer. Digestion., 56:25-30.
  17. Balanzo J Sainz S, Such J, et al. (1988) Encloscopic hemostasis by local injection of epinephrine and polidocanol in bleeding ulcer: a prospective randomized trial. Endoscopy., 20: 289-291.
  18. Church NI, Palmer KR. (2003) Ulcers an non variceal bleeding Endoscopy., 35 (122-6).
  19. Andriulli A, Annese V. (2005) Proton pump inhibitors and outcome of Endoscopic hemostasis in bleeding peptic ulcers: A series of meta analysis. Am J Gastroenterol., 100: 1-13.
  20. Zuckerman G, Welch R, Douglas A, et al. (1984) Active upper gastrointestinal bleeding and prevention of rebleeding. Am J Med Controlled trial of medical therapy for., 76: 361-366.
  21. Khoshbaten M, Fattahi E. Naderi N, Rezailashkejani M. (2006) A Companson or oral omeprazole and intravenous cimetidine in reducing complications of peptic ulcer. BMC Gastroenterol., 6:2.
 

[Bashir Ahmad Mir, Farhat Mustafa, Nishat I Iram and G M Gulzar. (2019); OUTCOME OF ORAL VS. INTRAVENOUS ESOMEPRAZOLE IN BLEEDING PEPTIC ULCER (SRH+) AFTER ENDOSCOPIC TREATMENT. Int. J. of Adv. Res. 7 (Mar). 541-548] (ISSN 2320-5407). www.journalijar.com

Dr. Farhat Mustafa
Senior Resident Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar -190011, J & K, India.

DOI:

Article DOI: 10.21474/IJAR01/8668      
DOI URL: https://dx.doi.org/10.21474/IJAR01/8668

Download Full Paper

Download PDF No. of Downloads: 15 | No. of Views: 79