Landmark Papers in Critical Care: Gastrointestinal bleeding

Gastrointestional Bleeding:

Lau JYW, et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med 2000;343:310-6.

One dreaded complication after endoscopic intervention for a GI bleed is rebleeding. This RCT from Hong Kong examined whether acid suppression (PPI) would prevent rebleeding. Two hundred and forty patients with a high risk of recurrent bleed, defined as active bleeding or a visible vessel at the time of endoscopy, who were post-endoscopic epinephrine injection or thermocoagulation were enrolled. It’s important to note that these patients were HIGH risk, and that patients with more shallow ulcers and no active bleeding were excluded.

Half of the patients received IV PPI drip, and the other half received placebo. After the infusion both groups received oral omeprazole 20 mg/day for 8 weeks. Omeprazole decreased he rate of rebleeding (6.7% in omeprazole group vs. 22.5% in the placebo group, p<0.001) and need for blood transfusions at 30 days. However, there was no demonstrated statistically significant mortality benefit.

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