Lege Artis Medicinae

[ENDOSCOPIC AND INTRAVENOUS PROTON PUMP INHIBITOR THERAPIES IN THE TREATMENT OF GASTRODUODENAL ULCER BLEEDING]

DÖBRÖNTE Zoltán

APRIL 21, 2006

Lege Artis Medicinae - 2006;16(04)

[Gastroduodenal peptic ulcer disease accounts for nearly 50% of the cases of acute upper gastrointestinal tract bleeding. Despite early endoscopic diagnosis and treatment, bleeding recurs in 15-20% of the cases within 72 hours. Mortality of recurrent bleeding is high (25-30%), therefore, the main goal of the treatment of patients with bleeding peptic ulcer is not only to stop the bleeding but also to prevent recurrence. The most effective way of the endoscopic therapy is the combination of injection (epinephrine) and thermal coagulation, with supplemental clip placement in spurting arterial bleeding. Overlying adherent clot should be removed after epinephrine has been injected into the ulcer base and the exposed vessel lesion should be coagulated. Proton pump inhibitors promote platelet aggregation and inhibit the proteolytic digestion of clots by raising the pH of gastric juice. The nearly neutral pH necessary for clot stability can be achieved by an intravenous bolus injection of the proton pump inhibitor followed by continuous infusion for 72 hours, after which an oral proton pump inhibitor should be used to prevent late recurrence of bleeding. Proton pump inhibitors can thus contribute significantly to the maintenance of primary haemostasis in patients with bleeding peptic ulcer. Beside omeprazole and pantoprazole that have been available as intravenous proton pump inhibitors, intravenous esomeprazole is a promising new product for the treatment of bleeding peptic ulcer since it ensures a faster and more pronounced intragastric pH increase.]

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