Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding
Authors: Angelo Andriulli, Vito Annese, Gioacchino Leandro
Journal: Annals of Internal Medicine (2004)

Letters6 July 2004Managing Patients with Nonvariceal Upper Gastrointestinal BleedingAngelo Andriulli, MD, Vito Annese, MD, and Gioacchino Leandro, MDAngelo Andriulli, MDFrom 71013 San Giovanni Rotondo, Italy.Search for more papers by this author, Vito Annese, MDFrom 71013 San Giovanni Rotondo, Italy.Search for more papers by this author, and Gioacchino Leandro, MDFrom 71013 San Giovanni Rotondo, Italy.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-1-200407060-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We congratulate the members of the Nonvariceal Upper GI Bleeding Consensus Conference Group for their guidelines on managing patients with nonvariceal bleeding (1). We disagree, however, with recommendation 17, which stresses the value of an intravenous bolus followed by continuous infusion of proton-pump inhibitors for decreasing rebleeding in patients who have undergone successful endoscopic therapy. The statement is ambiguous and only partially true.In the 4 trials cited by the authors as confirmatory evidence (2-5), high-dose continuous infusions of proton-pump inhibitors administered in combination with endoscopic therapy were compared with endoscopic therapy and placebo (2), cimetidine (3, ...References1. Barkun A, Bardou M, Marshall JK. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2003;139:843-57. [PMID: 14623622] LinkGoogle Scholar2. Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, et al . Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med. 2000;343:310-6. [PMID: 10922420] CrossrefMedlineGoogle Scholar3. Hasselgren G, Lind T, Lundell L, Aadland E, Efskind P, Falk A, et al . Continuous intravenous infusion of omeprazole in elderly patients with peptic ulcer bleeding. Results of a placebo-controlled multicenter study. Scand J Gastroenterol. 1997;32:328-33. [PMID: 9140154] CrossrefMedlineGoogle Scholar4. Lin HJ, Lo WC, Lee FY, Perng CL, Tseng GY. A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy. Arch Intern Med. 1998;158:54-8. [PMID: 9437379] CrossrefMedlineGoogle Scholar5. Goletti O, Sidoti F, Lippolis PV, De Negri F, Cavina E. Omeprazole versus ranitidine plus somatostatin in the treatment of severe gastroduodenal bleeding: a prospective, randomized, controlled trial. Ital J Gastroenterol. 1994;26:72-4. [PMID: 7913348] MedlineGoogle Scholar6. Udd M, Miettinen P, Palmu A, Heikkinen M, Janatuinen E, Pasanen P, et al . Regular-dose versus high-dose omeprazole in peptic ulcer bleeding: a prospective randomized double-blind study. Scand J Gastroenterol. 2001;36:1332-8. [PMID: 11761026] CrossrefMedlineGoogle Scholar7. Schonekas H, Ahrens H, Pannewick U, Ell C, Koop H, Petrisch W, Klein M, et al . Comparison of two doses of intravenous pantoprazole in peptic ulcer bleeding [Abstract]. Gastroenterology. 1999;116:A305. Google Scholar8. Andriulli A, Annese V, Caruso N, Pilotto A, Accadia L, Quitadamo M, et al. Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers. A meta-analysis. Am J Gastroenterol [In press]. Google Scholar Author, Article, and Disclosure InformationAuthors: Angelo Andriulli, MD; Vito Annese, MD; Gioacchino Leandro, MDAffiliations: From 71013 San Giovanni Rotondo, Italy. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoConsensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Alan Barkun , Marc Bardou , and John K. Marshall , for the Nonvariceal Upper GI Bleeding Consensus Conference Group*Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Kenneth M. Kessler Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Mohammed S. Khuroo and Mehnaaz S. Khuroo Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Alan Barkun , Marc Bardou , and John K. Marshall Metrics Cited byRisk of death and readmission of hospital-admitted COPD exacerbations: European COPD AuditReply to Dr. Barkun's Letter 6 July 2004Volume 141, Issue 1 Page: 78-79 Keywords Drugs Hemorrhage Lesions Patients Peptic ulcers Routes of administration Somatostatin ePublished: 6 July 2004 Issue Published: 6 July 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...