A team from England evaluated whether blood in the stomach at endoscopy reflects severity of bleeding and predicts clinical outcomes. They also investigated whether therapeutic agents could alter gastrointestinal (GI) bleeding.
A total of 414 consecutive admissions with suspected upper GI bleeding were included in the study.
Patients were randomized to receive one of four regimens. These were lansoprazole 60 mg followed by 30 mg four times daily, tranexamic acid 2 g followed by 1 g four times daily, both drugs, or placebo for four days, until discharge or a clinical end point occurred.
Logistic regression analysis was used to determine predictors of endoscopic changes and clinical outcomes, and to investigate the effects of drug treatments on blood in the stomach.
Of 414 patients with suspected upper GI bleeding, 379 were endoscoped. Upper GI bleeding was confirmed in 316.
Sixteen patients required surgery within 30 days and 16 died on the index admission.
Trial treatments were evaluable on a per protocol basis in 228 patients.
The amount of blood in the stomach was found to reflect initial risk. There were significant associations with high-risk categorization (odds ratio 3.7 for more than a trace versus none/trace), age (1.5 per decade), and initial pulse (1.02 per beat). The amount of blood also predicted re-bleeding (9.2) and surgery (8.2).
Other stigmata were less significant in these respects. The amount of blood in the stomach at endoscopy was reduced significantly by both lansoprazole (0.22) and tranexamic acid (0.27), although there was no evidence of synergy.
| Odds ratios of stomach in the blood at endoscopy:|
Tranexamic acid 0.27
Professor Chris Hawkey, of the University Hospital, Nottingham, concluded on behalf of the group, "Blood in the stomach reflects clinical features in patients with acute upper gastrointestinal bleeding, and is reduced by treatment with lansoprazole and tranexamic acid."