DRUGS FOR PH CONTROL IN ULCER GASTROINTESTINAL-BLEEDING

A few years ago, patients with bleeding peptic ulcers were referred to the surgeon if the bleeding did not stop. Today we have two promising new approaches to prevent emergency surgery. One is endoscopic interv ention, the other is the pharmacological approach of blocking the prot on pump. The endoscopical techniques of adrenaline injection, fibrin-' glue' injection, polidocanol injection and heat coagulation can stop a ctive bleeding in over 90% of cases. Pharmacologically, proton pump in hibitors can quickly achieve the optimal pH condition for support of t he physiological cascade of haemostasis. The aim is to keep the intrag astric pH above 6.0 for a few days. For the first time this aim can be achieved quickly and reliably by infusion of proton pump inhibitors. The optimal form of application is continuous infusion. Repeated bolus injections do not give optimal results. The optimal dosing was found to be the continuous infusion of 8 mg/h omeprazole or pantoprazole aft er an initial loading dose of 40-80 mg.