Dr. Anna Yaffee 52 in 52: Omeprazole in GI Bleed

Lau JY et al. 2007. Omeprazole before endoscopy in patients with gastrointestinal bleeding. NEJM. 356:1631-40. 

Take home points:

638 patients with upper GI bleed undergoing endoscopy were randomized to receive omeprazole vs placebo. The patients who received omeprazole prior to endoscopy had less need for intervention during endoscopy, fewer actively bleeding ulcers. A higher percentage of patients who received omeprazole had a hospital stay less than 3 days (60.5% vs 49.2% in placebo).


On further evaluation of the topic, a Cochrane review (Sreedharan A et al 2010. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev. 7:CD005415) of four RCTs on the subject found no statistical reduction in need for surgery, re-bleed, or death, although did confirm significant reduction in high risk lesions on endoscopy.


Bottom Line: PPI use may reduce appearance and risk of ulcers present on endoscopy, with unclear long term benefit in upper GI bleed.


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