Effect of a combination of omeprazole and high-dose proton pump inhibitors on the treatment of patients with liver cirrhosis complicated with upper gastrointestinal hemorrhage

Purpose: To determine the effect of a combination of omeprazole and high-dose proton pump inhibitor (PPI) on the treatment of patients with liver cirrhosis complicated with upper gastrointestinal hemorrhage.Methods: A total of 100 patients with liver cirrhosis and upper gastrointestinal hemorrhage who were admitted to Qingdao Chengyang District People’s Hospital from January 2019 to September 2020 were matched and randomly assigned to a control group and a study group. Patients in both groups received a high-dose PPI treatment, while those in the study group were given omeprazole in addition to highdose PPI. Total treatment effectiveness, incidence of adverse reactions, bleeding volume, hemostasis time, liver function after treatment, Quality of Life Index (QLI) scores, Visual Analogue Scale (VAS) scores, and bleeding (%) at 1, 2 and 4 weeks after treatment were compared for the two groups of patients.Results: Omeprazole-PPI combination produced a much more favorable outcome than treatment with only high-dose PPI, in terms of effectiveness, QLI scores and liver function (p < 0.05). The study group had significantly lower incidence of adverse reactions, bleeding volume, VAS scores, and degree of bleeding at 1, 2 and 4 weeks after treatment, as well as shorter hemostasis time, than the control group (p < 0.05).Conclusion: A combination treatment of omeprazole and high-dose PPI produces better therapeutic effect than high-dose PPI alone, in patients with liver cirrhosis and upper gastrointestinal hemorrhage.

Case Report: Lifesaving Hemostasis With Resuscitative Endovascular Balloon Occlusion of the Aorta in a Patient With Cardiac Arrest Caused by Upper Gastrointestinal Hemorrhage

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is performed to treat hemorrhagic shock, whose cause is located below the diaphragm. However, its use in patients with gastrointestinal hemorrhage is relatively rare. The 45-year-old man with a history of dilated cardiomyopathy had experienced epigastric discomfort and had an episode of presyncope. On his presentation, the patient's blood pressure was 82/64 mmHg, heart rate 140/min, and consciousness level GCS E4V5M6. Hemodynamics stabilized rapidly with a transfusion that was administered on an emergency basis, and a blood sample only showed mild anemia (Hb, 11.5 g/dL). The patient was admitted to investigating the presyncope episode, and the planned endoscopy was scheduled the following day. The patient had an episode of presyncope soon and was found in hemorrhagic shock resulting from a duodenal ulcer rapidly deteriorated to cardiac arrest. Although a spontaneous heartbeat was restored with cardiopulmonary resuscitation, the patient's hemodynamics were unstable despite the emergency blood transfusion administered by pumping. Consequently, a REBOA device was placed, resuscitation was continued, and hemostasis was achieved by vascular embolization for the gastroduodenal artery. The patient was subsequently discharged without complications. However, there is no established evidence regarding the REBOA use in upper gastrointestinal hemorrhage, and the investigations that have been reported have been limited. Further, one recent research suggests that appropriate patient selection and early use may improve survival in these life-threatening cases. As was seen in the present case, REBOA can effectively treat upper gastrointestinal hemorrhage by temporarily stabilizing hemodynamics and enabling a hemostatic procedure to be quickly performed during that time. This report also demonstrated the hemodynamics during the combination of intermittent and partial REBOA to avoid the complications of ischemic or reperfusion injury of the intestines or lower extremities.

A multicenter case–control study of the effect of e-nos VNTR polymorphism on upper gastrointestinal hemorrhage in NSAID users

Bleeding in non-steroidal anti-inflammatory drug (NSAID) users limited their prescription. This first multicenter full case–control study (325 cases and 744 controls), explored the association of e-NOS intron 4 variable number tandem repeat (VNTR) polymorphism with upper gastrointestinal hemorrhage (UGIH) in NSAID exposed and unexposed populations and assessed any interaction between this polymorphism and NSAIDs. NSAID users carrying e-NOS intron 4 wild type genotype or VNTR polymorphism have higher odds of UGIH than those unexposed to NSAIDs [Odds Ratio (OR): 6.62 (95% Confidence Interval (CI): 4.24, 10.36) and OR: 5.41 (95% CI 2.62, 11.51), respectively], with no effect modification from VNTR polymorphism-NSAIDs interaction [Relative Excess Risk due to Interaction (RERI): −1.35 (95% CI −5.73, 3.03); Synergism Index (S): 0.77 (95% CI 0.31, 1.94)]. Similar findings were obtained for aspirin exposure. Non-aspirin NSAID users who carry e-NOS intron 4 VNTR polymorphism have lower odds of UGIH [OR: 4.02 (95% CI 1.85, 8.75) than those users with wild type genotype [OR: 6.52 (95% CI 4.09, 10.38)]; though the interaction estimates are not statistically significant [RERI: −2.68 (95% CI −6.67, 1.31); S: 0.53 (95% CI 0.18, 1.55)]. This exploratory study suggests that the odds of UGIH in NSAID or aspirin users does not modify according to patient´s e-NOS intron 4 genotype.