Drugs for pH control in upper gastrointestinal bleeding

A few years ago, patients with bleeding peptic ulcers were referred to the surgeon if the bleeding did not stop. Today we have two promising new approaches to prevent emergency surgery. One is endoscopic intervention, the other is the pharmacological approach of blocking the proton pump. The endoscopical techniques of adrenaline injection fibrin-'glue' injection, polidocanol injection and heat coagulation can stop active bleeding in over 90% of cases. Pharmacologically, proton pump inhibitors can quickly achieve the optimal pH condition for support of the physiological cascade of haemostasis. The aim is to keep the intragastric pH above 6.0 for a few days. For the first time this aim can be achieved quickly and reliably by infusion of proton pump inhibitors. The optimal form of application is continuous infusion. Repeated bolus injections do not give optimal results. The optimal dosing was found to be the continuous infusion of 8 mg/h omeprazole or pantoprazole after an initial loading dose of 40-80 mg.