Categories: Gastrointestinal

Proton Pump Inhibitors for Upper GI Bleed: Mechanism

During the bleed, there will be sympathetic mediated vasoconstriction and also hemostasis (platelet plug).

It has been demonstrated in an acidic environment (6.0 compared physiological pH 7.4), there is a 2-4 fold prolongation of prothrombin time, aPTT, and thrombin time.

Thus, in an acidic environment, the coagulation cascade and platelet aggregation are inhibited and disaggregation of stable platelet plugs occurs.

In addition, pepsinogen is converted to pepsin under acidic conditions. Pepsin can lyse the blood clots that plug vessels in the ulcer base and induce re-bleeding thereafter.

REFERENCES

  1. Green F., Kaplan M., Curtis L., Levine P.. Effect of acid and pepsin on blood coagulation and platelet aggregation. A possible contributor prolonged gastroduodenal mucosal hemorrhage. Gastroenterology. 1978;74:38–43.
  2. Low J., Dodds A., Biggs J. Fibrinolytic activity of gastroduodenal secretions–a possible role in upper gastrointestinal haemorrhage. Thromb Res. 1980;17:819–830
  3. Leontiadis GI, Sharma VK, Howden CW. Proton pump inhibitor treatment for acute peptic ulcer bleeding. Cochrane Database Syst Rev. 2006:CD002094.
  4. Lin HJ. Role of proton pump inhibitors in the management of peptic ulcer bleeding. World Journal of Gastrointestinal Pharmacology and Therapeutics. 2010;1(2):51-53. doi:10.4292/wjgpt.v1.i2.51.
  5. Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, Chan FK, Ng EK, You JH, Lee CW, et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med. 2000;B:310–316.

 

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Dr. C Humphreys

Internal Medicine

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Dr. C Humphreys

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