1 / 6

Acid Suppresion in Upper GI Bleeding

Acid Suppresion in Upper GI Bleeding. Evidence Conference Fred Randolph, MD. H2-Blockers for Bleeding Peptic Ulcers. R. Collins, et al. Treatment with histamine H2 antagonists in acute upper gastrointestinal hemorrhage . NEJM 1985; 313:660-66.

uta
Download Presentation

Acid Suppresion in Upper GI Bleeding

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Acid Suppresion in Upper GI Bleeding Evidence Conference Fred Randolph, MD

  2. H2-Blockers for Bleeding Peptic Ulcers • R. Collins, et al. Treatment with histamine H2 antagonists in acute upper gastrointestinal hemorrhage. NEJM 1985; 313:660-66. • Meta-analysis of 27 studies using cimetidine or ranitidine in patients with upper GI bleeding with endpoints of persistent or recurrent bleeding, need for surgery and death. • Total N=2680 with wide range of outcomes: recurrent or persistent bleeding 10-45%, need for surgery 0-35% and death 0-10%.

  3. H2-Blockers for Bleeding Peptic Ulcers • R. P. Walt. et al. Continuous intravenous famotidine for haemorrhage from peptic ulcer. Lancet 1992; 340:1058-62. • Patients with hemorrhage from peptic ulcer with endoscopic signs of oozing, black slough, fresh clot or visible vessel. • A Famotidine (10 mg bolus followed by 3·2 mg/h intravenously) or matching placebo for 72 h. • Groups (n=1005) were similar in respect of age, sex, ulcer site, and signs and severity of bleeding • Case fatality (6·2% famotidine vs 5·0% placebo), rebleeding (23·9% vs 25·5% placebo), and surgery (15·5% vs 17·1% placebo) rates were not significantly different between the two groups. Conclusion: H2-Blockers do not influence the natural history of peptic ulcer hemorrhage.

  4. Proton Pump Inhibitors in Upper GI Bleeding Study: A Comparison of Omeprazole and Placebo for Bleeding Peptic Ulcer. Khurod et al. NEJM 1997; 336:1054-58 • Double blind placebo controlled trial between 1992-1994 based in 1 hospital (India). • All patients (n=860) with suspected upper GI bleeding were endoscoped. • Only those with duodenal, gastric or stomal ulcers with the additional finding of stigmata of recent hemorrhage were included (n=220). • Randomized to Omeperazole 40 mg po BID vs. placebo. • No statistically significant difference between groups.

  5. Outcomes

  6. HUPism If you are going to use acid suppression in Upper GI bleeding of unknown etiology, use a PPI and not an H2B.

More Related