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Review article: acid suppression in non-variceal acute upper gastrointestinal bleeding
A N Barkun1, A W Cockeram, V Plourde
1Division of Gastroenterology, McGill University, Montréal, Québec, Canada.
Alimentary Pharmacology & Therapeutics
|December 14, 1999
Summary
Proton pump inhibitors can maintain high gastric pH, reducing rebleeding and surgery rates in acute upper gastrointestinal bleeding. This offers a less invasive medical option for managing this serious condition.
Area of Science:
- Gastroenterology
- Internal Medicine
- Pharmacology
Background:
- Acute upper gastrointestinal (GI) bleeding has a persistent mortality rate of 6-7% despite improved management.
- Endoscopic therapy is standard, but less invasive medical treatments are sought to improve outcomes.
- Gastric acid impairs hemostasis and clot stability, suggesting a high intragastric pH is beneficial.
Purpose of the Study:
- To review non-variceal acute GI bleeding.
- To evaluate the role of proton pump inhibitors (PPIs) in managing acute GI bleeding.
- To assess the efficacy of maintaining a gastric pH above 6.0.
Main Methods:
- Review of clinical trial data on non-variceal acute GI bleeding.
- Analysis of the impact of gastric acid on hemostasis.
- Comparison of different medical modalities for managing GI bleeding.
Main Results:
- Intravenous proton pump inhibitors allow sustained elevation of gastric pH above 6.0 for 24 hours.
- Recent data suggest PPIs decrease rebleeding rates and the need for surgery.
- H2-receptor antagonists did not show significant improvements in patient outcomes.
Conclusions:
- Maintaining a high intragastric pH is theoretically warranted for acute GI bleeding.
- Proton pump inhibitors are a promising medical modality for reducing rebleeding and surgery in acute GI bleeding.
- PPIs represent a significant advancement in the medical management of non-variceal acute GI bleeding.