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Acid Suppresion in Upper GI Bleeding

Acid Suppresion in Upper GI Bleeding. Evidence Conference Fred Randolph, MD. H2-Blockers for Bleeding Peptic Ulcers. R. Collins, et al. Treatment with histamine H2 antagonists in acute upper gastrointestinal hemorrhage . NEJM 1985; 313:660-66.

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Acid Suppresion in Upper GI Bleeding

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  1. Acid Suppresion in Upper GI Bleeding Evidence Conference Fred Randolph, MD

  2. H2-Blockers for Bleeding Peptic Ulcers • R. Collins, et al. Treatment with histamine H2 antagonists in acute upper gastrointestinal hemorrhage. NEJM 1985; 313:660-66. • Meta-analysis of 27 studies using cimetidine or ranitidine in patients with upper GI bleeding with endpoints of persistent or recurrent bleeding, need for surgery and death. • Total N=2680 with wide range of outcomes: recurrent or persistent bleeding 10-45%, need for surgery 0-35% and death 0-10%.

  3. H2-Blockers for Bleeding Peptic Ulcers • R. P. Walt. et al. Continuous intravenous famotidine for haemorrhage from peptic ulcer. Lancet 1992; 340:1058-62. • Patients with hemorrhage from peptic ulcer with endoscopic signs of oozing, black slough, fresh clot or visible vessel. • A Famotidine (10 mg bolus followed by 3·2 mg/h intravenously) or matching placebo for 72 h. • Groups (n=1005) were similar in respect of age, sex, ulcer site, and signs and severity of bleeding • Case fatality (6·2% famotidine vs 5·0% placebo), rebleeding (23·9% vs 25·5% placebo), and surgery (15·5% vs 17·1% placebo) rates were not significantly different between the two groups. Conclusion: H2-Blockers do not influence the natural history of peptic ulcer hemorrhage.

  4. Proton Pump Inhibitors in Upper GI Bleeding Study: A Comparison of Omeprazole and Placebo for Bleeding Peptic Ulcer. Khurod et al. NEJM 1997; 336:1054-58 • Double blind placebo controlled trial between 1992-1994 based in 1 hospital (India). • All patients (n=860) with suspected upper GI bleeding were endoscoped. • Only those with duodenal, gastric or stomal ulcers with the additional finding of stigmata of recent hemorrhage were included (n=220). • Randomized to Omeperazole 40 mg po BID vs. placebo. • No statistically significant difference between groups.

  5. Outcomes

  6. HUPism If you are going to use acid suppression in Upper GI bleeding of unknown etiology, use a PPI and not an H2B.

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