Usage of intravenous forms of proton pump inhibitors
Abstract
Background: Upper gastrointestinal tract bleeding is a common clinical problem. However, there are no clear international guidelines for its management. Treatment of upper gastrointestinal bleeding with intravenous proton pump inhibitors is not an approved indication for the use of this group of medicines. Gastric acid has a central role in the pathophysiology of gastric and duodenal bleeding. The acidity of gastric juice is of key importance in mucosal injury as well as in the formation and disintegration of the blood clot, which prevents further bleeding. Before the introduction of proton pump inhibitors, systemically acting agents available were H2-receptor inhibitors. However, the efficacy of these agents decreas rapidly due to tachyphylaxis. Proton pump inhibitors are the most effective inhibitors of gastric secretion. As yet, none of the proton pump inhibitors for parenteral administration have been approved for the treatment of bleeding or the prevention of stress bleeding. The most extensive clinical experience is presently available for omeprazole. The usual dosage of omeprazole for the treatment of gastric or duodenal bleeding (ulcer, erosions) and for the prevention of stress bleeding is 80 mg by bolus injection, followed by infusion at a rate of 8 mg/hour. The lowest still effective dose in these indications has not yet been clearly determined and needs to be established in further studies.
Conclusions: Clinical studies have demonstrated that intravenous proton pump inhibitors are effective in the treatment of upper gastrointestinal tract bleeding. Further studies will be needed to finally establish their lowest still effective dose for the treatment of gastroduodenal bleeding and prevention of stress-induced bleeding.
Downloads
References
Kocijančič B. Krvavitve iz prebavil. In: Kocijančič A, Mrevlje F. Interna medicina. Ljubljana: EWO, d. o. o., 1998: 380–3.
Harris A, Stebbing J. Handbook of gastrintestinal emergencies. London: Life Science Communications Ltd.; 2002.
Skok P, Skok M. Krvaveča peptična razjeda: primerjava učinkovitosti dveh metod endoskopske hemostaze – prospektivna raziskava. Zdrav Vestn 2004; 73: 181–6.
Benedik T, Sever P, Benedik S. Kirurško zdravljenje bolnikov s krvavečo peptično razjedo. Gastroenterolog 2005; 20: 53–8.
Barkun A, Bardou M, Marshall JK. Consensus recommedations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2003; 139: 843–57.
Levy MJ, Seelig CB, Robinson NJ, Ranney JE. Comparison of omeprazole and ranitidine for stress ulcer prophylaxis. Digestive Disease and Sciences 1997; 42 (6): 1255–9.
Sackier JM, Halliday K, Sprott Ph, Coelho LGV, Batte JJ, Li SK, et al. The effects of intravenous omeprazole on 24 h gastric secretion in healthy subjects. Comparisons of continuous and intermittent infusions: a pilot study. Eu J Gastroenterol Hepatol 1991; 3: 679–84.
Merki HS, Wilder-Smith CH. Do continuous infusions of omeprazole and ranitidine retain their effect with prolonged dosing? Gastroenterol 1994; 106 (1): 60–4.
Levine JE, Leontiadis GI, Sharma VK, Howden CW. Meta-analysis: the efficacy of intravenous H2-receptor antagonists in bleeding peptic ulcer. Aliment Pharmacol Ther 2002; 16: 1137–42.
Maton PN. Review article: prevention of stress-related mucosal bleeding with proton-pump inhibitors. Aliment Pharmacol Ther 2005; 22 Supp 3: 45–52.
Leontiadis GI, Sharma VK, Howden CW. Proton pump inhibitor treatment for acute peptic ulcer bleeding (Review). The Cohrane Library 2006, Issue 1: 1–97.
Leontiadis GI, Sharma VK, Howden CW. Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding. BMJ 2005; 330: 568–6.
Leontiadis GI, Sharma VK, Howden CW. Systematic review and meta-analysis: proton pump inhibitor treatment for ulcer bleeding reduces transfusion requirements and hospital stay – results from the Cohrane Collaboration. Aliment Pharmacol Ther 2005; 22: 169–74.
Churh N, Palmer K. Acute non-variceal gastrointestinal hemorrhage: treatment. In: McDonald JWD, Burroughs AK, Feagan BG. Evidence based gastroenterology and hepatology. London: BMJ Books 1999: 118–39.
Anon. Stress ulcer prophylaxis in critically ill patients: resolving discordant meta-analyses (Structured abstract). Dostopno na: http://www.mrw.interscience.wiley.com/cochrane/cldare/articles/DARE-968048/frame.html (19. 5. 2006)
Laterre PF, Horsmans Y. Intravenous omeprazole in critically ill patients: a randomized, crossover study comparing 40 with 80 mg plus 8 mg/hour on intragastric pH. Critical care Medicine 2001; 29: 1931–5.
Zed PJ, Loewen PS, Slavik RS, Marra CA. Meta-analysis of proton pump inhibitors in treatment of bleeding peptic ulcers. Ann Pharmacother 2001; 35: 1528–34.
Cruickshand RH, Morrison DA, Bamber PA, Nimmo WS. Effect of i.v. omeprazole on the pH and volume of gastric contents before surgery. B J Aaesthesia 1989; 63: 536–40.
Triadafilopoulos G. Review article: the role of antisecretory therapy in the management of non-variceal upper gastrointestinal bleeding. Aliment Pharmacol Ther 2005; 22 Suppl 3: 53–58.
Anon. Stress ulcer prophylaxis. Dostopno na: http://www.cuhk.edu.hk/med/ans/Trainee %20Manual/General %20Management/Stress %20ulcer %20prophylaxis.pdf (19. 5. 2006)
Joynt G. Prevention and management of stress ulcers in the ICU. Dostopno na: http://www.aic.cuhk.edu.hk/web8/stress %20ulcers.htm (19. 5. 2006)
Allen ME, Kopp BJ, Erstad BL. Stress ulcer prophylaxis in the postoperative period. Dostopno na: http://www.medscape.com/viewarticle/472701_print (19. 5. 2006)
Pique JM, Feu F, de Prada G, Röhss K, Hasselgren G. Pharmacokinetics of omeprazole given by continuous intravenous infusion to patients with varying degrees of hepatic dysfunction. Clin Pharmacother 2002; 41: 999–1004.
Ell C. Komplikationen des peptischen Ulkus. In: Hahn EG, Riemann JF. Klinische Gastroenterologie. Stuttgart: Georg Thieme Verlag; 2000. p. 785–97.
Peterson WL, Laine L. Gastrointestinal bleeding. In: Sleisenger MH, Fordtran JS. Gastrointestinal disease. Philadelphia: Saunders company; 1993. p. 162–92.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
