Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Review

Volume 2, Number 1, February 2009, pages 1-7

Management of Αcute Non-Variceal Upper Gastrointestinal Bleeding: Drugs, Endoscopic Hemostasis, or Both?

**Table 1.** Effect of PPIs at diverse doses in the clinical outcome of patients with bleeding peptic ulcers
Studies (Ref. No)		N	Rebleeding	Surgery	Mortality
^*P < 0.05
Daneshmend et al. 1992 [21] 1147 patients with AUGIB (45% Peptic ulcer, 18% erosions)	Omeprazole 80mg followed by 40mg x 3 IV	578	18%	11%	5.3%
Placebo	569	1 5%	11%	6.9%
Comments: Reduction of stigmata of active or recent bleeding at endoscopy
Kurhoo et al. 1997 [22] 220 patients with peptic ulcer and stigmata of active or recent bleeding. (exclusion of 9 massive bleeding cases)	Omeprazole 40mg x 2 orally	110	10.9%	7.3%	1.8%
Placebo	110	40%*	23.6%*	5.4%
Comments: Younger patients as compared with the western world patients suffering from AUGIB
Hasselgren et al. 1997 [23] 322 patients ≥60 years old with AUGIB	Omeprazole 80mg bolus followed by 8mg/h	159	10%	8.1%	6.9%*
Placebo	163	18.5%*	14.1%*	0.6%
Βarkun et al. 2004 [24] 1244 patients >60 years old with bleeding peptic ulcer	Pantoprazole 80mg bolus followed by 8mg/h	Comments: Reduction of bleeding recurrences in pantoprazole group as compared with the group of H2-antagonists, but this effect was confined only in patients with active bleeding due to gastric ulcers.
Ranitidine 50mg bolus followed by 13.5mg/h

Table 1. Effect of PPIs at diverse doses in the clinical outcome of patients with bleeding peptic ulcers

Studies (Ref. No)

Rebleeding

Surgery

Mortality

^*P < 0.05

Daneshmend et al. 1992 [21]
1147 patients with AUGIB (45% Peptic ulcer, 18% erosions)

Omeprazole 80mg followed by 40mg x 3 IV

578

18%

11%

5.3%

Placebo

569

1 5%

11%

6.9%

Comments: Reduction of stigmata of active or recent bleeding at endoscopy

Kurhoo et al. 1997 [22]
220 patients with peptic ulcer and stigmata of active or recent bleeding. (exclusion of 9 massive bleeding cases)

Omeprazole 40mg x 2 orally

110

10.9%

7.3%

1.8%

Placebo

110

40%*

23.6%*

5.4%

Comments: Younger patients as compared with the western world patients suffering from AUGIB

Hasselgren et al. 1997 [23]
322 patients ≥60 years old with AUGIB

Omeprazole 80mg bolus followed by 8mg/h

159

10%

8.1%

6.9%*

Placebo

163

18.5%*

14.1%*

0.6%

Βarkun et al. 2004 [24]
1244 patients >60 years old with bleeding peptic ulcer

Pantoprazole 80mg bolus followed by 8mg/h

Comments: Reduction of bleeding recurrences in pantoprazole group as compared with the group of H2-antagonists, but this effect was confined only in patients with active bleeding due to gastric ulcers.

Ranitidine 50mg bolus followed by 13.5mg/h

**Table 2.** Effect of PPIs administration at diverse doses in clinical outcome of patients with bleeding peptic ulcer after endoscopic hemostasis
Studies (Ref. No)		Ν	Rebleeding	Surgery	Mortality
P<0.05 and *P=0.059
Javid et al 2001 [28] Endoscopic injection of adrenaline and polidocanol (India)	Omeprazole orally 40 mg x 2	82	7%	2.4%	1.2%
Placebo	84	21% *	8.3%	2.4%
Lau et al. 2000 [29] Endoscopic injection of adrenaline/thermal coagulation (Hong Kong)	Omeprazole 80mg bolus followed by 8 mg/h	120	6.7%	2.5%	4.2%
placebo	120	22.5% *	4.2%	10%
Jensen et al. 2006 [30] Endoscopic injection of adrenaline/thermal coagulation	Pantoprazole 80mg bolus followed by 8 mg/h IV	72	6.9%	3.5%	4.2%
Ranitidine 50mg followed by 6.25 mg/h IV	77	14.3% *	4.2%	3.9%
Ali Zargar et al. 2006 [31] Endoscopic injection of adrenaline/thermal coagulation (India)	pantoprazole 80mg bolus followed by 8 mg/h	102	7.8%	2.9%	2%
placebo	101	19.8% *	7.9%	4%
Udd et al. 2001 [32] Endoscopic injection of adrenaline/thermal coagulation	Omeprazole 80mg bolus followed by 8 mg/h	73	11.6%	7.2%	5.5%
Omeprazole 20 mg IV	69	8.2%	4.2%	2.9%
Kaviani et al. 2003 [33] Endoscopic injection of adrenaline (Iran)	Omeprazole 20 mg x 4	80	8.5%	1	0
placebo	80	33.3% *	1	1
Lin et al 2006 [34] Endoscopic injection of adrenaline (Taiwan)	Omeprazole 40 mg x 4 IV	67	9%	0%	0%
omeprazole 40 mg x 2 IV	66	21.2%	0%	1.5%
Cimetidine 400 mg x 2 IV	67	32.8% *	4.5%	4.4%
Lin et al. 1998 [35] Electro- or thermal coagulation	Οmeprazole 40mg bolus followed by 160 mg/day	50	4%	0	0
Cimetidine 300mg bolus followed by 12000 mg IV /day	50	24% *	0	2
Ηsu et al. 2004 [36] Ulcers with stigmata of active or recent bleeding after endoscopic injection	Pantoprazole 40mg bolus followed by 40 mg χ 2	52	3.8%	0	1.9%
Ranitidine 50mg bolus followed by 50 mg χ 4	50	16% *	2%	2%
Sung JY et al. 2008 [37] Ulcers with stigmata of active or recent bleeding after endoscopic injection	Esomeprazole 40 mg bolus followed by 8 mg/h x 3days	375	4.8%*	2.7%**	0.8%
placebo	389	10.4%	5.4%	2.1%

Table 2. Effect of PPIs administration at diverse doses in clinical outcome of patients with bleeding peptic ulcer after endoscopic hemostasis

Studies (Ref. No)

Rebleeding

Surgery

Mortality

*P<0.05 and **P=0.059

Javid et al 2001 [28]
Endoscopic injection of adrenaline and polidocanol (India)

Omeprazole orally 40 mg x 2

2.4%

1.2%

Placebo

21% *

8.3%

2.4%

Lau et al. 2000 [29]
Endoscopic injection of adrenaline/thermal coagulation (Hong Kong)

Omeprazole 80mg bolus followed by 8 mg/h

120

6.7%

2.5%

4.2%

placebo

120

22.5% *

4.2%

10%

Jensen et al. 2006 [30]
Endoscopic injection of adrenaline/thermal coagulation

Pantoprazole 80mg bolus followed by 8 mg/h IV

6.9%

3.5%

4.2%

Ranitidine 50mg followed by 6.25 mg/h IV

14.3% *

4.2%

3.9%

Ali Zargar et al. 2006 [31]
Endoscopic injection of adrenaline/thermal coagulation (India)

pantoprazole 80mg bolus followed by 8 mg/h

102

7.8%

2.9%

placebo

101

19.8% *

7.9%

Udd et al. 2001 [32]
Endoscopic injection of adrenaline/thermal coagulation

Omeprazole 80mg bolus followed by 8 mg/h

11.6%

7.2%

5.5%

Omeprazole 20 mg IV

8.2%

4.2%

2.9%

Kaviani et al. 2003 [33]
Endoscopic injection of adrenaline (Iran)

Omeprazole 20 mg x 4

8.5%

placebo

33.3% *

Lin et al 2006 [34]
Endoscopic injection of adrenaline (Taiwan)

Omeprazole 40 mg x 4 IV

omeprazole 40 mg x 2 IV

21.2%

1.5%

Cimetidine 400 mg x 2 IV

32.8% *

4.5%

4.4%

Lin et al. 1998 [35]
Electro- or thermal coagulation

Οmeprazole 40mg bolus followed by 160 mg/day

Cimetidine 300mg bolus followed by 12000 mg IV /day

24% *

Ηsu et al. 2004 [36]
Ulcers with stigmata of active or recent bleeding after endoscopic injection

Pantoprazole 40mg bolus followed by 40 mg χ 2

3.8%

1.9%

Ranitidine 50mg bolus followed by 50 mg χ 4

16% *

Sung JY et al. 2008 [37]
Ulcers with stigmata of active or recent bleeding after endoscopic injection

Esomeprazole 40 mg bolus followed by 8 mg/h x 3days

375

4.8%*

2.7%**

0.8%

placebo

389

10.4%

5.4%

2.1%