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Blood doesn't clot well in an acid environment such as the stomach. So researchers in Hong Kong hypothesised that intravenous omeprazole might be a good early treatment for patients waiting for endoscopy after an upper gastrointestinal bleed. They were right. In a randomised trial, patients given a continuous infusion of omeprazole before endoscopy were less likely to need endoscopic treatments to stop the bleeding than patients given placebo (relative risk for the omeprazole group 0.67, 95% CI 0.51 to 0.90). The effect was similar for the subgroup of patients with bleeding peptic ulcers (0.61, 0.44 to 0.84). Treatments included injections of adrenaline around bleeding vessels and thermocoagulationthermocoagulation.
Omeprazole didn't reduce patients' transfusion requirements, prevent recurrences, or save lives, and a similar proportion of each group needed emergency surgery to stop the bleeding. But patients given the drug were more likely to make it home from hospital in under three days (60.5% v 49.2%, P=0.005).
The researchers say their results confirm the notion that pre-emptive acid suppression can be beneficial for patients who are relatively stable and can afford to wait. But urgent endoscopy must remain the treatment of choice for patients who can't.