The potential clinical role of intravenous omeprazole

The efficacy of intravenous omeprazole has been investigated in a number of clinical applications. In critically ill patients with bleeding peptic ulcer, which developed despite prophylactic measures for stress ulcer, bleeding stopped in 16 out of 19 patients treated with omeprazole given as a 40-mg i.v. bolus twice daily for up to 5 days. By contrast, bleeding stopped in only 3 out of 20 such patients given a continuous infusion of ranitidine, 400 mg daily for the same time period. Dose-finding studies in volunteers showed that an initial bolus of omeprazole, 80 mg, followed by continuous infusion for 48 hours (8 mg/hour for the first 24 hours and 4 mg/hour for the subsequent 24 hours) produced elevation of gastric pH to 6 or above. This high-dose regimen when combined with infusion of large amounts of fluid was accompanied by peripheral oedema in three females, but did not occur when the dose was reduced to 4 mg/hour. In patients with non-bleeding ulcers who were unable to take oral medication, treatment with an intravenous bolus of omeprazole, 40 mg twice daily, healed 91% of gastric ulcers and 88% of duodenal ulcers in 2 weeks. In patients with temporary impairment of gastric emptying, resulting from pyloric oedema secondary to an ulcer in this region, an intravenous bolus of omeprazole, 40 mg three times daily, led to resolution of pyloric stenosis in seven out of nine patients with pre- and intra-pyloric ulcers, and in three out of five patients with post-pyloric ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy and safety of omeprazole in the long-term treatment of peptic ulcer and reflux oesophagitis resistant to ranitidine

A total of 143 patients with peptic ulceration of the duodenum, stomach and oesophagus who did not respond to 3 or more months of high-dose treatment with ranitidine, 450 mg or more daily, were treated with oral omeprazole, 40 mg daily. In 94% of the patients, ulcers healed within 2-8 weeks. After healing, 133 patients underwent long-term maintenance treatment with omeprazole, 40 mg daily, for 1-5 years (continuing). During maintenance therapy with omeprazole, no endoscopically verified relapses occurred, and no drug-related adverse effects were seen. There were no significant changes in routine laboratory tests in any patient, including 27 with concomitant liver cirrhosis. Basal serum gastrin levels, which were already elevated by the previous high-dose ranitidine treatment, rose to 4 times normal levels after 4 months of treatment with omeprazole. Thereafter, no further increases in basal serum gastrin levels were observed, even after 5 years of administration. The volume density of argyrophilic cells in the oxyntic mucosa increased during omeprazole treatment, but no dysplasia of the gastric enterochromaffin-like cells was seen. In conclusion, omeprazole was highly effective in healing ranitidine-resistant peptic ulcers, and subsequent maintenance therapy with omeprazole, 40 mg daily, was found to be effective and safe over the period observed.