Zdravniški Vestnik (Dec 2006)
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.
