A neutral gastric pH is critical for the stability of clots over bleeding arteries.
Dr James Lau and colleagues from China investigated the effect of preemptive infusion of omeprazole before endoscopy on the need for endoscopic therapy.
Consecutive patients admitted with upper gastrointestinal bleeding underwent stabilization.
The investigative team then randomly assigned 638 patients to receive either omeprazole or placebo before endoscopy the next morning.
There were 319 patients in each group assessed over a 17-month period.
The investigators found that the need for endoscopic treatment was lower in the omeprazole group than in the placebo group.
| Hospital stay was less than 3 days in 61% receiving omeprazole|
|New England Journal of Medicine|
There were no significant differences between the omeprazole group and the placebo group in the mean amount of blood transfused.
The team observed no differences between the groups in the number of patients who had recurrent bleeding.
There was no difference between the groups in those who underwent emergency surgery, or who died within 30 days.
The investigators noted that hospital stay was less than 3 days in 61% of patients in the omeprazole group, as compared with 50% in the placebo group.
On endoscopy, fewer patients in the omeprazole group had actively bleeding ulcers.
The team found that more omeprazole-treated patients had ulcers with clean bases.
Dr Lau's team concludes, “Infusion of high-dose omeprazole before endoscopy accelerated the resolution of signs of bleeding in ulcers and reduced the need for endoscopic therapy.”