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OMEPRAZOLE FOR BLEEDING SEPTIC ULCER.

Many clinicians treat upper gastrointestinal bleeding with H2-antagonists despite a lack of solid evidence supporting their use. In addition, a previous study suggested that the proton-pump inhibitor omeprazole was ineffective for unselected patients with acute upper GI bleeding (see Journal Watch Accession Number 920207004 or BMJ 1992; 304:143). This study from India examined whether omeprazole is effective for patients with bleeding peptic ulcer.

Researchers randomized 220 patients with acutely bleeding, endoscopically proven, peptic ulcers (83 percent of which were duodenal) to receive omeprazole (40 mg orally twice a day for 5 days) or placebo. Continued or recurrent bleeding was significantly less likely with omeprazole than placebo (11 vs. 36 percent). Omeprazole recipients were also less likely to require surgery (7 vs. 23 percent) or transfusion (29 vs. 71 percent). Subgroups of patients with nonbleeding visible vessels or adherent clots at the time of initial endoscopy benefited from omeprazole, but those with arterial spurting or oozing from the ulcer did not.

Comment: These results are dramatic, but they apply only to patients with ulcers, not those with other causes of bleeding. Moreover, unlike patients treated in most western countries, these patients did not undergo therapeutic endoscopic interventions because they were unavailable. While the use of omeprazole in selected patients makes sense, an editorial concludes that "it is premature" to use the drug routinely in this setting.

— AS Brett

Published in Journal Watch General Medicine April 18, 1997

Citation(s):

Khuroo MS et al. A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med 1997 Apr 10 336 1054-1058.

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• Medline abstract (Free)

Saltzman JR and Zawacki JK. Therapy for bleeding peptic ulcers. N Engl J Med 1997 Apr 10 336 1091-1093.

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• Medline abstract (Free)