High-dose Omeprazole Research Articles

Eosinophilic Esophagitis Presenting as Hiccups

Purpose: A 24 year old woman was referred to our care in March 2011 with a 3 year history of persistent hiccups and mild, intermittent dyspepsia. Her symptoms began with occasional mild chest discomfort lasting one minute followed by bouts of hiccups but progressed to up to ten episodes per day. She had no prior medical history other than one admission for renal calculi and her only prescription was birth control pills. She had no history of allergy and no known family history of illness as she was adopted. Six months before our evaluation she was treated empirically with ranitidine with no relief in her symptoms. She underwent esophagogastroduodenoscopy (EGD), which demonstrated trachealization of the esophagus and biopsies from the distal esophagus showed significant eosinophilic infiltration. She was subsequently placed on a 6 week course of high-dose omeprazole (40 mg twice daily), with minimal relief of her symptoms. A follow-up EGD showed persistent esophageal eosinophilia (peak eosinophils count of 23 per high power field) consistent with a diagnosis of eosinophilic esophagitis (EoE) (Figure 1). The patient was started on topical fluticasone (440 mcg twice daily). Within 1 week of treatment her symptoms improved substantially, with hiccups occurring fewer than 2 times per week. After 6 weeks her chest discomfort and hiccups resolved entirely. A post-treatment EGD demonstrated resolution of trachealization and histological remission of EoE. In conclusion, hiccups may be associated with eosinophilic esophagitis. Thus, EoE should be considered in the differential diagnosis of patients with refractory hiccups.Figure: Hematoxylin and eosin from esophageal biopsy shows large numbers of intraepithelial eosinophils as well as multiple degranulated eosinophils.

Randomized controlled trial of standard versus high-dose intravenous omeprazole after endoscopic therapy in high-risk patients with acute peptic ulcer bleeding

Rebleeding from peptic ulcers is a major contributor to death. This study compared standard (40-mg intravenous infusion of omeprazole once daily for 3 days) and high-dose (80-mg bolus of omeprazole followed by 8-mg/h infusion for 72 h) in reducing the rebleeding rate (primary endpoint), need for surgery, duration of hospital stay and mortality in patients with peptic ulcer bleeding after successful endoscopic therapy. This was a single-institution prospective randomized controlled study based on a postulated therapeutic equivalence of the two treatments. All patients who had successful endoscopic haemostasis of a bleeding peptic ulcer (Forrest classification Ia, Ib, IIa or IIb) were recruited. Informed consent was obtained and patients were randomized to receive standard- or high-dose infusions of intravenous omeprazole. Two (3 per cent) of 61 patients in the high-dose group and ten (16 per cent) of 61 in the standard-dose group exhibited rebleeding, a difference of - 13 (95 per cent confidence interval - 25 to - 2) per cent. The upper limit of the one-sided confidence interval exceeded a predefined equivalence absolute difference of 16 per cent. Equivalence of standard- and high-dose omeprazole in preventing rebleeding was not demonstrated. Intravenous standard-dose omeprazole was inferior to high-dose omeprazole in preventing rebleeding after endoscopic haemostasis for peptic ulcer bleeding. NCT00519519 (http://www.clinicaltrials.gov).

Gastroesophageal reflux disease management according to contemporary international guidelines: A translational study

To test the Genval recommendations and the usefulness of a short trial of proton pump inhibitor (PPI) in the initial management and maintenance treatment of gastroesophageal reflux disease (GERD) patients. Five hundred and seventy seven patients with heartburn were recruited. After completing a psychometric tool to assess quality of life (PGWBI) and a previously validated GERD symptom questionnaire (QUID), patients were grouped into those with esophagitis (EE, n = 306) or without mucosal damage (NERD, n = 271) according to endoscopy results. The study started with a 2-wk period of high dose omeprazole (omeprazole test); patients responding to this PPI test entered an acute phase (3 mo) of treatment with any PPI at the standard dose. Finally, those patients with a favorable response to the standard PPI dose were maintained on a half PPI dose for a further 3-mo period. The test was positive in 519 (89.9%) patients, with a greater response in EE patients (96.4%) compared with NERD patients (82.6%) (P = 0.011). Both the percentage of completely asymptomatic patients, at 3 and 6 mo, and the reduction in heartburn intensity were significantly higher in the EE compared with NERD patients (P < 0.01). Finally, the mean PGWBI score was significantly decreased before and increased after therapy in both subgroups when compared with the mean value in a reference Italian population. Our study confirms the validity of the Genval guidelines in the management of GERD patients. In addition, we observed that the overall response to PPI therapy is lower in NERD compared to EE patients.

Study on the prevention effects of high-dose omeprazole in the treatment of stress-related mucosal injury

Objective To study the therapeutic effects of omeprazoie in high-dose given by continuous intravenous infusion in the treatment of stress-related mucosal injury of G-I tract in intensive care patients.Method Totally 98 intensive care patients with stress-related mucosal injury(SRMI)were enrolled from August 2006 to October 2008 Department in Intensive Care Unit(ICU)of the Provincial Hospital Affiliated to Shandong University.All the patients were randomly divided into high-dose omeprazoie group(group A)and control group(group B).In group A,omeprazoie was administrated in loading dose of 80 mg Ⅰ.Ⅴ.in 5 minutes followed by maintenance dose of 8.0 mg/h intravenous infusion for 72 hours,while in group B,omeprazoie was given in dose of 40mg/8h intravenous infusion for 72 hours.The pH value of gastric juice was determined by German Roche pH test paper every 2 to 8 hours in the patients of both groups.The coffee like or red juice in the gastrointestine decompressor was observed.At the same time,hemoglobin(HB)was detected by Automatic blood cell analyzer Sysmex XE-2100,blood urea nitrogen(BUN)was determined by Automatic Analyzer Au5400,and buffer excess(BE)was checked by GEM Premie arterial blood gas analyzer in all patients.Data were expressed as mean ± standard deviation(x-± s)and the analysis of variance was done with SPSS 12.0 software.Comparison of mean value between two groups was conducted with t-test and the ratio was calculated by using chi-square test(X2 test).The change was considered as statistically significant if P value was less than 0.05.Results Four,eight,and 24 hours after treatment with omeprazole,the pH values in patients of group A were higher than those in patients of group B(four hous:6.63 ±0.62 vs.3.14 ±0.26,P＜0.01;eight hours and 24 hours:P＜0.05 or P＜0.01).At 8 hours and 24 hours after treatment,the HB was higher,BUN and BE were lower in group A than those in group B(P＜0.03 or P＜0.01).The total rate of hemostasis of upper G-I tract bleeding in group A was higher than that in group B(95.35%vs.78.19%,P＜0.05).Conclusions For treating the intensive care patients with SRMI,the continues intravenous infusion of omeprazole inhigh dose is superior to conventional dosage. Key words: Proton pump inhibitors; Omeprazole; Intensive care patients; Stress-related mucosal injury; Therapy effect

226 Scheduled 2nd Endoscopy or High Dose Omeprazole Infusion in Preventing Peptic Ulcer Rebleeding - A Prospective Randomized Trial

and quantified CagA translocation by Western blot using anti-phosphotyrosine and antiCagA antibodies. Significantly higher levels of CagA were translocated by the 7.13 0310mutant compared to wild-type H. pylori strain 7.13. By utilizing proteomics technology to contrast two closely related H. pylori strains that induce distinct phenotypes, we have shown that HP0310 may function to alter levels of peptidoglycan, thereby affecting the composition of substrates translocated by the cag secretion system. These studies also provide an important foundation for investigating the role of bacterial virulence factors in H. pylori-induced pathologic sequelae, as such results would ultimately allow for generation of a profile of H. pylori proteins to use for screening persons infected with strains most likely to induce severe disease.

Proton pump inhibitors and recurrent bleeding in peptic ulcer disease

Peptic ulcer disease (PUD) is one of the main lesions responsible for upper gastrointestinal (GI) bleeding, as well as esophageal varices and Mallory-Weiss tear. Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs)/aspirin are the major responsible causes. In cases of upper GI bleeding, urgent endoscopy is performed after stabilization of vital signs. There are several modalities for controlling bleeding in PUD, such as ethanol injection or hypertonic saline with epinephrine. Recurrent bleeding occurs in 20% of patients after endoscopic therapy. The combination of endoscopic intervention and a proton pump inhibitor (PPI) is necessary to achieve hemostasis of active bleeding. It has been reported that high-dose omeprazole (80 mg bolus injection, then 8 mg/h continuous infusion for 72 h, then 40 mg/day orally for 1 week) can reduce recurrent bleeding, the need for surgery and mortality from hemorrhagic shock in patients with high-risk peptic ulcer bleeding, as compared with standard-dose omeprazole. The metabolism of PPIs is dependent upon P450 2C19 genotypes and the clinical usefulness of genotypic analysis remains to be determined.

Cost-effectiveness analysis of high-dose omeprazole infusion before endoscopy for patients with upper-GI bleeding

The use of intravenous (i.v.) proton pump inhibitors (PPI) before an endoscopy in upper-GI bleeding (UGIB) was shown to reduce the need of endoscopic therapy and shorten hospital stay. To investigate whether preemptive use of a PPI in UGIB is a cost-effective strategy. A decision analysis model that represents treatment pathways for patients with UGIB was constructed and structuralized by 30-day outcomes. Direct costs of medical treatment, diagnostic and therapeutic endoscopy, endoscopic re-treatment, surgery, and hospitalization were analyzed. Prince of Wales Hospital, Hong Kong. A total of 631 patients were recruited. Sixty patients (19.1%) in the PPI group and 90 patients (28.4%) in the placebo group required endoscopic hemostasis at index endoscopy. The primary measurements were cost-effectiveness ratios and incremental cost-effectiveness ratios (ICER) to avert endoscopic therapy between PPI and placebo treatment. Sensitivity analyses were conducted by varying the cost of endoscopy, hospitalization, the incidence rate of endoscopic therapy, and the proportion of bleeding peptic ulcers. The overall direct cost per patient was U.S. dollars (USD) $2813 for PPI treatment and USD $2948 for the placebo. A PPI reduced endoscopic therapy by 7.4% and resulted in a lower cost-effectiveness ratio per endoscopic therapy averted (USD $3561) than the placebo (USD $4117). The ICER value was USD -$1843, which indicated that preemptive PPI treatment is more effective and less costly for UGIB. When the proportions of patients with peptic ulcer bleeding were greater than 8.3%, the preemptive PPI treatment remained cost saving. Preemptive use of IV PPI before an endoscopy is a cost-effective strategy in the management of UGIB.

Clinical trial: the effects of adding ranitidine at night to twice daily omeprazole therapy on nocturnal acid breakthrough and acid reflux in patients with systemic sclerosis – a randomized controlled, cross‐over trial

Gastro-oesophageal reflux disease (GERD) is an important problem in systemic sclerosis due to impaired salivation and oesophageal function. To determine the efficacy of adding ranitidine at bedtime to control nocturnal acid breakthrough (NAB) and GERD in patients with systemic sclerosis already prescribed high-dose omeprazole. Patients with systemic sclerosis and GERD symptoms (n = 14) were treated with omeprazole 20 mg b.d. and either placebo or ranitidine 300 mg at bedtime for 6 weeks in a randomized, cross-over, placebo controlled study. At the end of each period a 24 h pH-study with intragastric and oesophageal pH measurement was performed. Pathological acid reflux occurred in eight patients with omeprazole/placebo and in seven with omeprazole/ranitidine (P = ns) with technically adequate oesophageal pH-studies (n = 13). NAB was present in eight patients with omeprazole/placebo and six with omeprazole/ranitidine (P = ns) in whom technically adequate gastric pH-studies were obtained (n = 10). The addition of ranitidine had no consistent effect on patient symptoms or quality of life. Many patients with systemic sclerosis experienced NAB and pathological oesophageal acid exposure despite high-dose acid suppression with omeprazole b.d. Adding ranitidine at bedtime did not improve NAB, GERD or quality of life in this population.

Early infusion of high-dose omeprazole before endoscopy reduced the need for endoscopic therapy

Source Citation Lau JY, Leung WK, Wu JC, et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med. 2007;356:1631-40. 17442905

High-dose omeprazole is more beneficial than standard-dose in patients with high-risk peptic ulcer bleeding,

High-dose omeprazole is more beneficial than standard-dose in patients with high-risk peptic ulcer bleeding,

Epstein–Barr virus-associated smooth muscle tumour mimicking bilateral vocal process granuloma

A case is presented of a 36-year-old Chinese woman with a renal transplant for end-stage renal failure due to Goodpasture's syndrome. She presented with a year's history of throat discomfort and acid regurgitation into her throat. Videolaryngoscopy revealed bilateral vocal process granuloma, presumed to be due to gastroesophageal reflux. A four-week course of high dose omeprazole was prescribed. On follow up a month later, the granulomas had enlarged, and laser excision was undertaken. Histological and immunohistochemical staining was consistent with Epstein-Barr virus-associated smooth muscle tumour. This is believed to be the first reported case in the English literature of such a tumour affecting the vocal process. The aim of this paper is to present the pathogenesis, clinical behaviour and treatment of Epstein-Barr virus-associated smooth muscle tumour, and to review the literature concerning the differential diagnosis of polypoid vocal process lesions.

Omeprazole before Endoscopy in Patients with Gastrointestinal Bleeding

A neutral gastric pH is critical for the stability of clots over bleeding arteries. We investigated the effect of preemptive infusion of omeprazole before endoscopy on the need for endoscopic therapy. Consecutive patients admitted with upper gastrointestinal bleeding underwent stabilization and were then randomly assigned to receive either omeprazole or placebo (each as an 80-mg intravenous bolus followed by an 8-mg infusion per hour) before endoscopy the next morning. Over a 17-month period, 638 patients were enrolled and randomly assigned to omeprazole or placebo (319 in each group). The need for endoscopic treatment was lower in the omeprazole group than in the placebo group (60 of the 314 patients included in the analysis [19.1%] vs. 90 of 317 patients [28.4%], P=0.007). There were no significant differences between the omeprazole group and the placebo group in the mean amount of blood transfused (1.54 and 1.88 units, respectively; P=0.12) or the number of patients who had recurrent bleeding (11 and 8, P=0.49), who underwent emergency surgery (3 and 4, P=1.00), or who died within 30 days (8 and 7, P=0.78). The hospital stay was less than 3 days in 60.5% of patients in the omeprazole group, as compared with 49.2% in the placebo group (P=0.005). On endoscopy, fewer patients in the omeprazole group had actively bleeding ulcers (12 of 187, vs. 28 of 190 in the placebo group; P=0.01) and more omeprazole-treated patients had ulcers with clean bases (120 vs. 90, P=0.001). Infusion of high-dose omeprazole before endoscopy accelerated the resolution of signs of bleeding in ulcers and reduced the need for endoscopic therapy. (ClinicalTrials.gov number, NCT00164866 [ClinicalTrials.gov] .).

Bolus Versus Continuous High-Dose Omeprazole Infusion Combined with Endoscopic Hemostasis in Peptic Ulcer Bleeding. A Randomized, Multicenter, Italian Study

Bolus Versus Continuous High-Dose Omeprazole Infusion Combined with Endoscopic Hemostasis in Peptic Ulcer Bleeding. A Randomized, Multicenter, Italian Study

Continuous infusion of high‐dose omeprazole is more effective than standard‐dose omeprazole in patients with high‐risk peptic ulcer bleeding: a retrospective study

High-dose omeprazole reduces the rate of recurrent bleeding after endoscopic treatment of peptic ulcer bleeding. However, the effectiveness of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding has never been shown. To compare the benefits of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding. We reviewed the medical files of patients admitted between 1997 and 2004 for high-risk peptic ulcer bleeding who had undergone successful endoscopic treatment. We distinguished 2 periods: before 2001, standard-dose omeprazole (40 mg/day intravenously until alimentation was possible, then 40 mg/day orally for 1 week); after 2001, high-dose omeprazole (80 mg bolus injection, then 8 mg/h continuous infusion for 72 h, then 40 mg/day orally for 1 week). During both periods, patients subsequently received omeprazole, 20 mg/day, orally for 3 weeks. We enrolled 114 patients (period 1, n = 45, period 2, n = 69). Therapy with high-dose omeprazole significantly decreased the occurrence of poor outcome (27 vs. 12%, P = 0.04), rebleeding (24 vs. 7%, P = 0.01), mortality due to haemorrhagic shock (11 vs. 0%, P < 0.001) and need for surgery (9 vs. 1%, P = 0.05). In this retrospective study, high-dose omeprazole reduced the occurrence of rebleeding, need for surgery and mortality due to hemorrhagic shock in patients with high-risk peptic ulcer bleeding, as compared with standard-dose omeprazole.

Continuous Infusion or Repeated Intravenous Bolus Injection of High-Dose Omeprazole in Patients at High Risk of Rebleeding from Peptic Ulcers?

Continuous Infusion or Repeated Intravenous Bolus Injection of High-Dose Omeprazole in Patients at High Risk of Rebleeding from Peptic Ulcers?

PPIs or H

Convincing data show that high-dose omeprazole therapy decreases the rebleeding rate among patients who have ulcers with endoscopic stigmata for

High-dose or low-dose omeprazole after endoscopic hemostasis in patients with peptic ulcer bleeding?

High-dose or low-dose omeprazole after endoscopic hemostasis in patients with peptic ulcer bleeding?

The effect of regular and high doses of omeprazole on the intragastric acidity in patients with bleeding peptic ulcer treated endoscopically: a clinical trial with continuous intragastric pH monitoring

In peptic ulcer bleeding (PUB), pH level >4 is considered necessary to prevent dissolving of a formed fibrin clot. The effect of regular or high doses of omeprazole on the intragastric pH in patients with acute PUB was studied. In our earlier study, after endoscopic therapy, PUB patients were randomized to receive a regular dose of intravenous omeprazole (20 mg; i.e. 60 mg/3 days) or a high dose of omeprazole (80 mg bolus + 8 mg/h; i.e. 652 mg/3 days). Of these 142 analysed and reported patients, 13 PUB patients also had intragastric pH monitoring for these 3 days; seven of these patients had a regular dose and six received a high dose of omeprazole. The mean 24-h intragastric pH (regular versus high dose) on day 1 was 4.9 +/- 1.6 versus 6.3 +/- 0.5 (P = 0.035), on day 2 was 4.9 +/- 1.8 versus 6.7 +/- 0.3 (P = 0.001), and on day 3 was 5.7 +/- 1.1 versus 6.7 +/- 0.5 (P = NS). The medians of the intragastric pH were 6 versus 6.5 (P = 0.082) on day 1, 5.8 versus 6.8 (P = 0.001) on day 2, and 6.2 versus 6.8 (P = 0.17) on day 3. The proportion of time when pH <4 on day 1 was 29.2 +/- 34.1 versus 5.4 +/- 5.7% (P = NS). A regular dose of omeprazole raises the mean and median 24-h intragastric pH >4 in patients with PUB. This reduction in the acidity together with endoscopic therapy is probably sufficient to maintain haemostasis. A high dose of omeprazole keeps the pH almost constantly >6.

Gastric pH, sevelamer hydrochloride and omeprazole

Sevelamer hydrochloride is a polymer containing multiple amines (40% amine hydrochloride) separated by one carbon from the polymer backbone, and it is not absorbed by the intestine. These amines are partially protonated and interact with phosphate molecules through ionic and hydrogen bonding, therefore reducing phosphate absorption and lowering serum phosphate concentration. Alterations of gastric pH, in particular excessive alkalinization, could interfere with sevelamer phosphate binding capacity. A 30-year-old dialysis patient affected by secondary hyperparathyroidism started sevelamer treatment, 4.8 g/day, with a basal serum phosphate of 6.9 mg/dl. The patient was also treated with omeprazole (20 mg/day) because of chronic gastritis. Phosphate levels normalized (4.2 mg/dl), but after four months of follow-up serum phosphate unexpectedly increased to 7.2 mg/dl. We found out that in the same period she had autonomously increased the dosage of omeprazole to 80 mg/day, due to worsening of dyspepsia. Gastric pH measurement showed a median level of 4.1, rather than the normal values of 1 - 2, indicating excessive pharmacological alkalinization. When omeprazole was reduced to the correct dose of 20 mg/day, we observed a rapid decrease of phosphate levels. This case report highlights the influence of gastric pH on sevelamer phosphate binding capacity. The high dose of omeprazole and the consequent excessive increase in gastric pH was probably responsible for a decreased phosphate binding capacity of sevelamer. When patients taking appropriate doses of sevelamer do not respond to treatment, a potential interaction with drugs determining an increase of gastric pH should be considered.

Effect of Repeated Bolus Injection, Low- or High-Dose Continuous Infusion of Omeprazole on Intragastric pH in Patients With Bleeding Peptic Ulcer via Dose-Titration Study

Effect of Repeated Bolus Injection, Low or High Dose Continuous Infusion of Omeprazole on Intragastric pH in Patients With Bleeding Peptic Ulcer v a Dose-Titration Study Philip Wai Y., Simon Kin Hung Wong, Justin Chi Yuen Wu, Man Yee Yung, Wilfred Mui, Enders Kwok Wai Ng, James Yun Wong Lau, Joseph Sung Aim: From our previous study, we have shown that the adjunctive use of high dose omeprazole infusion reduced the rate of recurrent bleeding after endoscopic hemostasis for bleeding peptic ulcers. The appropriate dose of omeprazole to achieve optimal pH profile for clot stability is unknown. The aim of this study is to define the gastric acid suppression profile among various regimens of adjunctive omeprazole. Patients and Method: We included patients that presented with bleeding peptic ulcers and had endoscopic stigmata of either red dot or clean base that do not required endoscopic treatment. We excluded those that received regular antisecretory medications, NSAID/aspirin users, previous gastric surgery and moribund patients. All patients were randomly assigned to receive various dosage protocol of proton pump inhibitor for 24 hours, including 1. Omeprazole 80 mg bolus, then 8 mg/hr infusion (192 mg/d); 2. Omeprazole 80 mg bolus, then 4 mg/hr infusion (96 mg/d); or 3. Omeprazole intravenous 40 mg bolus 6 hourly (160 mg/d). We measured the 24 hour fasting gastric pH with the electrode positioned at 10 cm below the gastroesophageal junction. We collected the median pH, % time pH O 4 and % time pH O 6 at intervals of 1 hour, 4 hour, 12 hour and 24 hours after the start of therapy. We also analyzed the time needed to attain pH O 4 and pH O 6. Results: We included 30 patients with bleeding peptic ulcers that had endoscopic stigmata of either red dot or clean base. 11 patients received omeprazole 40 mg every 6 hourly, 10 patients received omeprazole 4mg/hr and 9 patients received omeprazole 8 mg/hr. The three groups were comparable in terms of age, body weight, ulcer size, initial blood pressure and hemoglobin level. There was no difference in the % time pH O 4 or 6 at 1, 4, 12 and 24 hours between the three groups. However, we found that those patients receiving omeprazole 8 mg/hr could reach pH O 4 in a significantly shorter time (Kruskal-Wallis test p Z 0.04) (Figure 1). Conclusion: Patients receiving a regime of high dose omeprazole infusion at 8mg/hr attained an intragastric pH profile of more than 4 in a significantly shorter period of time. A high dose regimen may be more effective in prevention of early recurrent rebleeding by early clot stabilization.