Korean J Gastrointest Endosc.
2009 May;38(5):247-253.
Pharmacological Therapy in Patients with Bleeding Peptic Ulcers
- Affiliations
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- 1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. jikim@catholic.ac.kr
Abstract
- The aim of pharmacological therapy in peptic ulcer disease is to increase the intragastric pH level above 6. The use of a proton pump inhibitor (PPI), a powerful gastric acid secretion inhibitor, has been proven as effective not only to control bleeding but also to reduce the rate of rebleeding. Maintainence of the intragastric pH level above 6 by the administration of a PPI prevents hemolysis caused by acid or pepsin and thereby promotes aggregation of platelets. Intragastric acid suppression can be achieved more effectively with continuous intravenous infusion of a PPI after intravenous bolus injection. However, oral administration of a PPI shows rapid onset, long duration of action and sufficient bioavailability. Therefore, both administration routes and pharmacologic properties of the drugs should be taken into account to gain the proper level of acid suppression above pH 6. Combination therapy with the use of endoscopic hemostatic treatment and intravenous PPI administration is known to result in the best outcome for peptic ulcer bleeding. In previous studies from South Korea, the use of combination therapy has also showed the best hemostaic outcome. However, pharmacological therapy with PPI alone can elevate and maintain intragastric pH above 6.0 and can result in hemostasis as similar to endoscopic hemostasis.
