gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1525Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГОВ, ГЕПАТОЛОГОВNATIONAL COLLEGE OF GASTROENTEROLOGISTS, HEPATOLOGISTSЭффективность антисекреторной терапии ингибиторами протонной помпы при гастродуоденальных язвенных кровотеченияхAntisecretory treatment efficacy by proton pump inhibitors at gastroduodenal ulcer bleedingsЕвсеевМ. А.EvseyevM. A.КлишинИ. М.KlishinI. M.Московская медицинская академия им. И.М. СеченоваRussian Federation2010300620102035562Copyright © Евсеев М.А., Клишин И.М., 20102010Евсеев М.А., Клишин И.М.Evseyev M.A., Klishin I.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1525

Цель обзора. Дать оценку клинической эффективности антисекреторных препаратов при гастродуоденальных язвенных кровотечениях.Основные положения. В качестве компонентов консервативного гемостаза парентеральные формы Н2-блокаторов продемонстрировали эффективность, статистически не отличающуюся от результатов плацебо. Мета-анализ 18 исследований установил, что непрерывная внутривенная инфузия омепразола достоверно снижает частоту повторной геморрагии. Парентеральное введение эзомепразола после проведенного эндоскопического гемостаза обеспечивает высокую эффективность в снижении частоты рецидивов язвенного кровотечения в первые 72 ч нахождения в стационаре, а также в течение последующих 7 и 30 сут.Заключение. Обосновано использование в клинической практике у пациентов с кровоточащими язвами желудка и двенадцатиперстной кишки после верифицированного эндоскопией состояния гемостаза продленного внутривенного введения эзомепразола с последующим переходом на пероральный прием препарата.

The aim of review

The aim of review. To assess clinical efficacy of antisecretory drugs at gastroduodenal ulcer bleedings.

Original positions

Original positions. Parenteral forms of Н2-blockers as conservative hemostasis components showed efficacy which statistically does not differ from that of placebo. Metaanalysis of 18 studies revealed, that continuous intravenous infusion of omeprazole significantly reduces frequency of recurrent hemorrhage. Parenteral injection of esomeprazole after endoscopic hemostasis provides highly effective decrease in frequency of recurrent ulcer bleeding in the first 72 hs of hospital stay, as well as for the next 7 and 30 days.

Conclusion

Conclusion. Prolonged intravenous injection of esomeprazole with subsequent intake of the drug per os is proved for application in clinical practice for patients with bleeding stomach and duodenum ulcers after endoscopical verification of hemostasis.

гастродуоденальные язвенные кровотеченияантисекреторные препаратыН2-блокаторыингибиторы протонной помпыфамотидиномепразолэзомепразолgastroduodenal ulcerative bleedingsantisecretory drugsН2-blockersproton pump inhibitorsfamotidineomeprazoleesomeprazoleReferencesBardou M., Toubouti Y., Benhaberou-Brun D. et al. Meta-analysis: proton-pump inhibition in high-risk patients with acute peptic ulcer bleeding // Aliment. Pharmacol. Ther. – 2005. – Vol. 21. – P. 677–686.Bardou M., Toubouti Y., Benhaberou-Brun D. et al. Meta-analysis: proton-pump inhibition in high-risk patients with acute peptic ulcer bleeding // Aliment. Pharmacol. Ther. – 2005. – Vol. 21. – P. 677–686.Barkun A, Sabbah S, Enns R, et al. RUGBE Investigators. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): Endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting // Am J Gastroenterol. – 2004. – Vol. 99. – P. 1238-1246.Barkun A, Sabbah S, Enns R, et al. RUGBE Investigators. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): Endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting // Am J Gastroenterol. – 2004. – Vol. 99. – P. 1238-1246.Barkun A., Bardou M., Marshall J.K. et al. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding // Ann. Intern. Med. – 2003. – Vol. 139, N. 10. – P. 843–857.Barkun A., Bardou M., Marshall J.K. et al. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding // Ann. Intern. Med. – 2003. – Vol. 139, N. 10. – P. 843–857.Daneshmend T.K., Hawkey C.J., Langmann M.J.S. et al. Omeprazole versus placebo for acute upper gastrointestinal bleeding: randomised double blind controlled trial // BMJ. – 1992. – Vol. 304. – P. 143–147.Daneshmend T.K., Hawkey C.J., Langmann M.J.S. et al. Omeprazole versus placebo for acute upper gastrointestinal bleeding: randomised double blind controlled trial // BMJ. – 1992. – Vol. 304. – P. 143–147.Green F.W.Jr., Kaplan M.M., Curtis L.E., Levine P.H. Effect of acid and pepsin on blood coagulation and platelet aggregation: a possible contributor to prolonged gastroduodenal mucosal hemorrhage // Gastroenterology. – 1978. – Vol. 74. – P. 38–43.Green F.W.Jr., Kaplan M.M., Curtis L.E., Levine P.H. Effect of acid and pepsin on blood coagulation and platelet aggregation: a possible contributor to prolonged gastroduodenal mucosal hemorrhage // Gastroenterology. – 1978. – Vol. 74. – P. 38–43.Hassan-Alin M., Andersson T., Bredberg E., Rohss K. Pharmacokinetics of esomeprazole after oral and intravenous administration of single and repeated doses to healthy subjects // Eur. J. Clin. Pharmacol. – 2000. – Vol. 56. – P. 665–670.Hassan-Alin M., Andersson T., Bredberg E., Rohss K. Pharmacokinetics of esomeprazole after oral and intravenous administration of single and repeated doses to healthy subjects // Eur. J. Clin. Pharmacol. – 2000. – Vol. 56. – P. 665–670.Hasselgren G., Lind T., Lundell L. et al. Continuous intravenous infusion of omeprazole in elderly patients with peptic ulcer bleeding // Scand. J. Gastroenterol. – 1997. – Vol. 32. – P. 328–332.Hasselgren G., Lind T., Lundell L. et al. Continuous intravenous infusion of omeprazole in elderly patients with peptic ulcer bleeding // Scand. J. Gastroenterol. – 1997. – Vol. 32. – P. 328–332.Hasselgren G., Rohss K., Hedenstrom H. Effect of esomeprazole 40 mg vs omeprazole 40 mg on 24-hour intragastric pH in patients with symptoms of GERD // Dig. Dis. Sci. – 2002. – Vol. 47, N 5. – Р. 954–958.Hasselgren G., Rohss K., Hedenstrom H. Effect of esomeprazole 40 mg vs omeprazole 40 mg on 24-hour intragastric pH in patients with symptoms of GERD // Dig. Dis. Sci. – 2002. – Vol. 47, N 5. – Р. 954–958.Khuroo M.S., Yattoo G.N., Javid G. et al. А comparison of omeprazole and placebo for bleeding peptic ulcer // N. Engl. J. Med. – 1997. – Vol. 336. – P. 1054–1058.Khuroo M.S., Yattoo G.N., Javid G. et al. А comparison of omeprazole and placebo for bleeding peptic ulcer // N. Engl. J. Med. – 1997. – Vol. 336. – P. 1054–1058.Lau J.Y. et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers // N. Engl. J. Med. – 2000. – Vol. 343.Lau J.Y. et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers // N. Engl. J. Med. – 2000. – Vol. 343.– P. 310.– P. 310.Lau J.Y., Leung W.K., Wu J.C. et al. Early administration of high-dose intravenous omeprazole prior to endoscopy in patients with upper gastrointestinal bleeding: a double blind placebo controlled randomized trial // Gastroenterology. – 2005. – Vol. 128 (suppl. 2). – P. 50.Lau J.Y., Leung W.K., Wu J.C. et al. Early administration of high-dose intravenous omeprazole prior to endoscopy in patients with upper gastrointestinal bleeding: a double blind placebo controlled randomized trial // Gastroenterology. – 2005. – Vol. 128 (suppl. 2). – P. 50.Lin H.J., Lo W.C., Lee F.Y. et al. A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy // Arch. Intern. Med. – 1998. – Vol. 158. – P. 54–58.Lin H.J., Lo W.C., Lee F.Y. et al. A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy // Arch. Intern. Med. – 1998. – Vol. 158. – P. 54–58.Lind T., Rydberg L., Kyleback A. et al. Esomeprazole provides imroved acid control versus omeprazole in patients with symptoms of gastro-oesophageal reflux disease // Aliment. Pharmacol. Ther. – 2000. – Vol. 14. – P. 861–867.Lind T., Rydberg L., Kyleback A. et al. Esomeprazole provides imroved acid control versus omeprazole in patients with symptoms of gastro-oesophageal reflux disease // Aliment. Pharmacol. Ther. – 2000. – Vol. 14. – P. 861–867.Miner Ph., Katz Ph., Cheng Y. Gastric acid control with esomeprazole, lansoprazole, omeprasole, pantoprazole and rabeprasole: a five-way crossover study // Am. J. Gastroenterol. – 2003. – Vol. 98, N 12.Miner Ph., Katz Ph., Cheng Y. Gastric acid control with esomeprazole, lansoprazole, omeprasole, pantoprazole and rabeprasole: a five-way crossover study // Am. J. Gastroenterol. – 2003. – Vol. 98, N 12.Netzer P., Gaia C., Sandoz M. et al. Effect of repeated injection and continuous infusion of omeprazole and ranitidine on intragastric pH over 72 hours // Am. J. Gastroenterol. – 1999. – Vol. 94. – P. 351–357.Netzer P., Gaia C., Sandoz M. et al. Effect of repeated injection and continuous infusion of omeprazole and ranitidine on intragastric pH over 72 hours // Am. J. Gastroenterol. – 1999. – Vol. 94. – P. 351–357.Rohss K., Lind T., Wilder-Smith C. Esomeprazole (40 mg) provides more effective intragastric acid control than lansoprazole (30 mg), omeprazole (40 mg), pantoprazole (40 mg), rabeprazole (40 mg) in patients with gastrooesophageal reflux symptoms // Eur. J. Clin. Pharmacol.Rohss K., Lind T., Wilder-Smith C. Esomeprazole (40 mg) provides more effective intragastric acid control than lansoprazole (30 mg), omeprazole (40 mg), pantoprazole (40 mg), rabeprazole (40 mg) in patients with gastrooesophageal reflux symptoms // Eur. J. Clin. Pharmacol.– 2004. – Vol. 60. – P. 531–539.– 2004. – Vol. 60. – P. 531–539.Sung J.J., Mössner J., Barkun A., et al. Intravenous esomeprazole for prevention of peptic ulcer re-bleeding: rationale/design of Peptic Ulcer Bleed study // Aliment. Pharmacol. Ther. – 2008. – Vol. 27. – P. 666-677.Sung J.J., Mössner J., Barkun A., et al. Intravenous esomeprazole for prevention of peptic ulcer re-bleeding: rationale/design of Peptic Ulcer Bleed study // Aliment. Pharmacol. Ther. – 2008. – Vol. 27. – P. 666-677.Sung J.J., Barkun A., Kuipers E.J. et al. Intravenous esomeprazole for prevention of recurrent peptic ulcer bleeding: a randomized trial // Ann. Intern. Med. – 2009. – Vol. 150, N 7. – P. 455-464.Sung J.J., Barkun A., Kuipers E.J. et al. Intravenous esomeprazole for prevention of recurrent peptic ulcer bleeding: a randomized trial // Ann. Intern. Med. – 2009. – Vol. 150, N 7. – P. 455-464.Walt R.P., Cottrell J., Mann S.G. et al. Continuous intravenous famotidine for haemorrhage from peptic ulcer // Lancet. – 1992. – Vol. 340. – P. 1058–1062.Walt R.P., Cottrell J., Mann S.G. et al. Continuous intravenous famotidine for haemorrhage from peptic ulcer // Lancet. – 1992. – Vol. 340. – P. 1058–1062.Walt R.P., Reynolds J.R., Langman M.J. et al. Intravenous omeprazole rapidly raises intragastric pH // Lancet. – 1992. – Vol. 340. – P. 1062–1068.Walt R.P., Reynolds J.R., Langman M.J. et al. Intravenous omeprazole rapidly raises intragastric pH // Lancet. – 1992. – Vol. 340. – P. 1062–1068.Wilder-Smith C., Bondarov P., Lindgren M. et al. Intravenous esomeprazole (40 mg and 20 mg) inhibits gastric acid secretion as effectively as oral esomeprazole: results of two randomized clinical studies // Eur. J. Gastroenterol. Hepatol. – 2005. – Vol. 17. – P. 191–197.Wilder-Smith C., Bondarov P., Lindgren M. et al. Intravenous esomeprazole (40 mg and 20 mg) inhibits gastric acid secretion as effectively as oral esomeprazole: results of two randomized clinical studies // Eur. J. Gastroenterol. Hepatol. – 2005. – Vol. 17. – P. 191–197.

The authors declare that there are no conflicts of interest present.