Effects of different omeprazole dosing on gastric pH in non‐variceal upper gastrointestinal bleeding: A randomized prospective study. Issue 9 (September 2016)

• Record Type: Journal Article
• Authors: Chwiesko, Adam; Charkiewicz, Radoslaw; Niklinski, Jacek; Luczaj, Wojciech; Skrzydlewska, Elzbieta; Milewski, Robert; Baniukiewicz, Andrzej; Wroblewski, Eugeniusz; Rosolowski, Mariusz; Dabrowski, Andrzej
• Is Part Of: Journal of digestive diseases. Volume 17:Issue 9(2016:Sep.)
• Page Start: 588
• Page End: 599
• Publication Date: 2016-09
• Subjects: CYP2C19 -- Helicobacter pylori -- intragastric pH -- non‐variceal upper gastrointestinal bleeding -- proton pump inhibitor; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; 616.3
• DOI: 10.1111/1751-2980.12393
• Languages: English
• ISSNs: 1751-2972

Abstract

Abstract: Objective: We aimed to identify the best method of omeprazole (OME) application with respect to intragastric pH, cytochrome P450 2C19 (CYP2C19) genotype and phenotype. Methods: The patients with non‐variceal upper gastrointestinal bleeding (NVUGIB) were prospectively enrolled. After the achievement of endoscopic hemostasis, the patients were randomized to 40‐mg intravenous ( i.v. ) OME bolus injection every 12 h or 8‐mg/h continuous i.v. infusion for 72 h after an 80‐mg i.v. OME bolus administration. The intragastric pH was recorded for 72 h. The CYP2C19 variant alleles (*2, *3, *17) were analyzed and the serum concentrations of OME and 5‐hydroxyomeprazole (5‐OH OME) were determined. Results: Altogether 41 Caucasians (18 in the OME infusion [OI] group and 23 in the OME bolus [OB] group) were analyzed. The median percentage of time with an intragastric pH > 4.0 was higher in the infusion group than in the OB group over 48 h (100% vs 96.6%, P = 0.009) and 72 h (100% vs 87.6%, P = 0.006), and that at an intragastric pH >6.0 was higher in the OI group than the OB group over 72 h (97.9% vs 63.5%, P = 0.04). Helicobacter pylori infection was correlated with the fastest increase in intragastric pH, especially in the OI group. In both groups, CYP2C19 genotypes (*1/*1, *1/*17, *17/*17) had no essential effect on intragastric pH. Conclusions: In patients with NVUGIB, OME i.v. bolus followed by continuous infusion is more effective than OME i.v. bolus every 12 h in maintaining higher intragastric pH, regardless of CYP2C19 genetic polymorphisms. H . pylori infection accelerates the initial elevation of intragastric pH.