EBQ:Omeprazole in Bleeding Peptic Ulcers: Difference between revisions

Revision as of 21:14, 4 September 2015

incomplete Journal Club Article

Lau JYW, et al. "Effect of Intravenous Omeprazole on Recurrent Bleeding after Endoscopic Treatment of Bleeding Peptic Ulcer". NEJM. 2000. 343(5):310-316.
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Clinical Question

Does high dose intravenous omeprazole reduce the incidence of recurrent bleeding in patients who have undergone endoscopic intervention for bleeding peptic ulcers?

Conclusion

High-dose infusion of omeprazole after endoscopic treatment of bleeding peptic ulcers substantially reduces the risk of recurrent bleeding.

Major Points

Study Design

All investigators remained unaware of the patients’ treatment assignments until the study was completed.

Population

Patient Demographics

Omeprazole vs. Placebo
Male: 66.7% vs. 66.7%
Age: 64 vs. 67
Hemoglobin (g/dL): 9.4 vs. 9.5
Location of ulcer:

Stomach: 44% vs. 40%

Duodenum: 54% vs. 54%

Stoma: 2% vs. 6%

Endoscopic signs of bleeding:

Spurting hemorrhage: 12% vs. 8%

Oozing hemorrhage: 42% vs. 41%

Nonbleeding visible vessel: 32% vs. 30%

Clot with underlying vessel: 15% vs. 22%

Size of ulcer (cm): 1.2 vs. 1.1
Previous ulcer disease: 32% vs. 38%
Previous ulcer bleeding: 30% vs. 30%
Recent use of H2 antagonist or PPI: 2% vs. 2%
Risk factor of bleeding peptic ulcer:

H.pylori infection: 65% vs. 53%

Use of NSAIDs: 33% vs. 33%

Use of aspirin: 19% vs. 15%

Use of warfarin: 4% vs. 4%

Development of bleeding during hospitalization: 18% vs. 19%
Pts with coexisting illnesses: 25% vs. 30%

Inclusion Criteria

Exclusion Criteria

Interventions

After endoscopic treatment, patients were randomly assigned to receive an intravenous infusion of placebo or omeprazole, given as an 80-mg bolus injection followed by a continuous infusion of 8 mg per hour for a period of 72 hours.
- Identical-appearing vials of omeprazole and placebo were prepared with random numbers in blocks of 80
- Treatment was started in the recovery area of the endoscopy suite and continued in a surgical ward.

Outcomes

Primary Outcome

Secondary Outcomes

Subgroup analysis

Criticisms & Further Discussion

Funding

Sources

Authors:

@@ Line 17: / Line 17: @@
 ==Conclusion==
+High-dose infusion of omeprazole after endoscopic treatment of bleeding peptic ulcers substantially reduces the risk of recurrent bleeding.
 ==Major Points==
 ==Study Design==
+*All investigators remained unaware of the patients’ treatment assignments until the study was completed.
 ==Population==
 ===Patient Demographics===
+'''Omeprazole vs. Placebo''' <br/>
+Male: 66.7% vs. 66.7% <br/>
+Age: 64 vs. 67 <br/>
+Hemoglobin (g/dL): 9.4 vs. 9.5 <br/>
+Location of ulcer:
+:Stomach: 44% vs. 40%
+:Duodenum: 54% vs. 54%
+:Stoma: 2% vs. 6%
+Endoscopic signs of bleeding:
+:Spurting hemorrhage: 12% vs. 8%
+:Oozing hemorrhage: 42% vs. 41%
+:Nonbleeding visible vessel: 32% vs. 30%
+:Clot with underlying vessel: 15% vs. 22%
+Size of ulcer (cm): 1.2 vs. 1.1 <br/>
+Previous ulcer disease: 32% vs. 38% <br/>
+Previous ulcer bleeding: 30% vs. 30% <br/>
+Recent use of H2 antagonist or PPI: 2% vs. 2% <br/>
+Risk factor of bleeding peptic ulcer:
+:H.pylori infection: 65% vs. 53%
+:Use of NSAIDs: 33% vs. 33%
+:Use of aspirin: 19% vs. 15%
+:Use of warfarin: 4% vs. 4%
+Development of bleeding during hospitalization: 18% vs. 19% <br/>
+Pts with coexisting illnesses: 25% vs. 30%
 ===Inclusion Criteria===
 ===Exclusion Criteria===
 ==Interventions==
+*After endoscopic treatment, patients were randomly assigned to receive an intravenous infusion of placebo or omeprazole, given as an 80-mg bolus injection followed by a continuous infusion of 8 mg per hour for a period of 72 hours.
+**Identical-appearing vials of omeprazole and placebo were prepared with random numbers in blocks of 80
+**Treatment was started in the recovery area of the endoscopy suite and continued in a surgical ward.
 ==Outcomes==