We retrospectively investigated the efficacy of high dose
omeprazole compared to a combined
therapy of
famotidine,
pirenzepine and
antacid for acute upper
gastrointestinal hemorrhage (AUGIH) also adjuvant to endoscopic injection
therapy if indicated. The
clinical course of AUGIH was evaluated, if emergency endoscopy revealed lesions substantially dependent on intragastric acidity with respect to pathogenesis and/or healing (
peptic ulcer, erosive gastroduodenitis,
reflux-esophagitis, Mallory-Weiss tears) and patients either received a combined
therapy of
famotidine (20 mg i.v. every 12 hrs),
pirenzepine (10 mg i.v. every 12 hrs) and
antacid (control group: n = 96) or
omeprazole (40 mg i.v. every 6 hrs;
omeprazole group: n = 100). Rate of rebleeding was lower in the
omeprazole group without reaching significance (12 vs. 21; p = 0.06). No difference was found for rates of operation (6 vs. 6; p = 0.94), death from
bleeding (5 vs. 9; p = 0.22), transfusions ([mean +/- SD] 3.3 +/- 5.0 vs. 3.2 +/- 5.7; p = 0.51) and hospitalisation ([mean +/- SD] 26.8 +/- 12.1 vs. 27.8 +/- 16.0 days; p = 0.88). Considering prognostic risk factors (age > or = 65, actively
bleeding lesion, initial state of
shock) logistic regression showed that high dose
omeprazole inhibited rebleeding (p = 0.01) but had no effect as regards surgery or mortality. Within two selected subgroups defined by additional criteria (no endoscopic treatment and anamnestic peptic lesion)
omeprazole-treated cases showed lower rates of rebleeding (3/49 vs. 12/54, p " 0.02 and 3/44 vs. 13/48, p = 0.01 resp.) and death from
bleeding (0/46 vs. 6/50, p = 0.03 and 0/43 vs. 5/45, p = 0.03 resp.).(ABSTRACT TRUNCATED AT 250 WORDS)