PubMed · 11979871
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Hideyuki Hiraishi, Kazunari Kanke, Akira Terano. 2002. [Sucralfate].. https://pubmed.ncbi.nlm.nih.gov/11979871/
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BACKGROUND: Five proton pump inhibitors are now available for use in North America. Claims of differences in the clinical efficacy of different strengths and/or agents have been made. AIM: To identify any consistent evidence of differences in outcomes between agents or doses within this class of drugs. METHODS: A search of the medical literature was performed in two electronic databases, and randomized controlled trials of higher quality were included in the assessment. RESULTS AND CONCLUSIONS: Thirty-two trials met our criteria. No convincing data were found to indicate that low doses of proton pump inhibitors are as effective as standard doses of proton pump inhibitors in the healing of erosive oesophagitis or in the relief of symptoms of gastro-oesophageal reflux disease; however, they may be as effective as maintenance therapy for gastro-oesophageal reflux disease and peptic ulcer disease. Differences were found between the standard doses of proton pump inhibitors with regard to the onset of symptom relief in gastro-oesophageal reflux disease (lansoprazole was faster than omeprazole, and esomeprazole was faster than both lansoprazole and omeprazole) and the healing of oesophagitis (esomeprazole was superior to both omeprazole and lansoprazole). Despite these differences, there are as yet insufficient data to establish the superiority of any one agent over all others across all disease states treated with these agents.
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BACKGROUND: The optimal treatment of ulcers with nonbleeding visible vessels and adherent clots is unclear. OBJECTIVE: To compare intravenous omeprazole infusion plus endoscopic therapy with intravenous omeprazole infusion alone for prevention of recurrent bleeding from ulcers with nonbleeding visible vessels or adherent clots. DESIGN: Single-blind randomized study with blinded evaluation of study end points. SETTING: An endoscopy center in a university hospital in Hong Kong. PATIENTS: 156 persons with upper gastrointestinal bleeding and ulcers showing nonbleeding visible vessels or adherent clots. INTERVENTION: Combination of endoscopic therapy and omeprazole infusion versus sham endoscopic therapy and omeprazole infusion. MEASUREMENTS: Recurrent ulcer bleeding before discharge and within 30 days. RESULTS: 78 patients were recruited in each group. Ulcer bleeding recurred before discharge in seven patients who received intravenous omeprazole alone (9%) and no patients who received combined therapy (difference, 9 percentage points [95% CI, 1.7 to 17.6 percentage points]; P = 0.01). The probability of recurrent bleeding within 30 days was 11.6% (9 patients) in the omeprazole-alone group and 1.1% (1 patient) in the combined therapy group (difference, 10.5 percentage points [CI, 1.7 to 19.8 percentage points]; P = 0.009). Patients in the combined therapy group required less transfusion (difference in median units of blood transfused, 1 unit [CI, 0 to 2 units]; P = 0.02). One patient in the combined therapy group had surgery for ulcer perforation. Four patients receiving omeprazole alone (5.1%) and two patients receiving combined therapy (2.6%) died within 30 days. CONCLUSION: The combination of endoscopic therapy and omeprazole infusion is superior to omeprazole infusion alone for preventing recurrent bleeding from ulcers with nonbleeding visible vessels and adherent clots.