Document Detail


Proton pump inhibitors and recurrent bleeding in peptic ulcer disease.
MedLine Citation:
PMID:  19120905     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Peptic ulcer disease (PUD) is one of the main lesions responsible for upper gastrointestinal (GI) bleeding, as well as esophageal varices and Mallory-Weiss tear. Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs)/aspirin are the major responsible causes. In cases of upper GI bleeding, urgent endoscopy is performed after stabilization of vital signs. There are several modalities for controlling bleeding in PUD, such as ethanol injection or hypertonic saline with epinephrine. Recurrent bleeding occurs in 20% of patients after endoscopic therapy. The combination of endoscopic intervention and a proton pump inhibitor (PPI) is necessary to achieve hemostasis of active bleeding. It has been reported that high-dose omeprazole (80 mg bolus injection, then 8 mg/h continuous infusion for 72 h, then 40 mg/day orally for 1 week) can reduce recurrent bleeding, the need for surgery and mortality from hemorrhagic shock in patients with high-risk peptic ulcer bleeding, as compared with standard-dose omeprazole. The metabolism of PPIs is dependent upon P450 2C19 genotypes and the clinical usefulness of genotypic analysis remains to be determined.
Authors:
Akihiro Tajima; Kazuhito Koizumi; Kazuyoshi Suzuki; Naoko Higashi; Morio Takahashi; Tadahito Shimada; Akira Terano; Hideyuki Hiraishi; Hajime Kuwayama
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  23 Suppl 2     ISSN:  1440-1746     ISO Abbreviation:  J. Gastroenterol. Hepatol.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2009-01-05     Completed Date:  2009-04-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  S237-41     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, Japan. atajima@dokkyomed.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aryl Hydrocarbon Hydroxylases / genetics,  metabolism
Combined Modality Therapy
Continental Population Groups / genetics
Drug Administration Schedule
Duodenal Ulcer / complications,  drug therapy*,  ethnology
Genotype
Hemostasis, Endoscopic
Humans
Peptic Ulcer Hemorrhage / ethnology,  etiology,  prevention & control*
Proton Pump Inhibitors / administration & dosage*,  pharmacokinetics
Recurrence
Shock, Hemorrhagic / etiology,  prevention & control
Stomach Ulcer / complications,  drug therapy*,  ethnology
Treatment Outcome
Chemical
Reg. No./Substance:
0/Proton Pump Inhibitors; EC 1.14.14.1/Aryl Hydrocarbon Hydroxylases; EC 1.14.14.1/CYP2C19 protein, human

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