Belei Oana, Olariu Laura, Puiu Maria, Jinca Cristian, Dehelean Cristina, Marcovici Tamara, Marginean Otilia
First Pediatric Clinic, University of Medicine and Pharmacy Victor Babes , Romania.
First Pediatric Clinic, University of Medicine and Pharmacy Victor Babes .
Rev Esp Enferm Dig. 2018 Jun;110(6):352-357. doi: 10.17235/reed.2018.4864/2017.
the majority of studies of acute gastrointestinal bleeding in children are retrospective, focusing on therapeutic endoscopy. Previous studies performed in adult patients have demonstrated that both scheduled second look endoscopy and high dose continuous omeprazole infusion are effective in the prevention of peptic ulcer rebleeding. The aim of this study was to compare the efficacy of these two strategies using esomeprazole for the prevention of rebleeding following primary endoscopic hemostasis in children with peptic ulcers. The main outcome was to assess the rebleeding rate within 30 days after the initial hemostasis.
consecutive pediatric cases who underwent endoscopic treatment for bleeding peptic ulcers were randomized into two treatment groups following hemostasis. The first group received esomeprazole as an intravenous bolus every 12 hours for 72 hours and a routine second look endoscopy within 12-24 hours with endotherapy retreatment in the case of a persistent stigmata of bleeding. The second group received a continuous high dose esomeprazole infusion for 72 hours without endoscopic reassessment unless required due to rebleeding.
a total of 63 children were randomized to the second look endoscopy group and 64 to the esomeprazole infusion group. Rebleeding occurred within 30 days in four patients (6.3%) in the first group and in three patients (4.6%) in the second group (p = 0.7).
a pharmaceutical approach using a high dose continuous esomeprazole infusion in children after an initial endoscopic hemostasis has a similar efficacy compared to second look endoscopy and bolus esomeprazole administration for the prevention of peptic ulcer rebleeding. Thus, the discomfort of a second endoscopy in children can be avoided and is only recommended for selected high risk cases.
大多数关于儿童急性胃肠道出血的研究都是回顾性的，重点在于治疗性内镜检查。此前在成年患者中进行的研究表明，计划性二次内镜检查和高剂量持续输注奥美拉唑在预防消化性溃疡再出血方面均有效。本研究的目的是比较这两种使用埃索美拉唑预防消化性溃疡患儿初次内镜止血后再出血的策略的疗效。主要结局是评估初次止血后30天内的再出血率。
因出血性消化性溃疡接受内镜治疗的连续儿科病例在止血后被随机分为两个治疗组。第一组每12小时静脉推注一次埃索美拉唑，共72小时，并在12 - 24小时内进行常规二次内镜检查，若存在持续出血迹象则进行内镜再治疗。第二组持续高剂量输注埃索美拉唑72小时，除非因再出血需要，否则不进行内镜重新评估。
共有63名儿童被随机分配至二次内镜检查组，64名被分配至埃索美拉唑输注组。第一组有4名患者（6.3%）在30天内发生再出血，第二组有3名患者（4.6%）发生再出血（p = 0.7）。
在初次内镜止血后，对儿童采用高剂量持续输注埃索美拉唑的药物治疗方法与二次内镜检查及推注埃索美拉唑预防消化性溃疡再出血的疗效相似。因此，可以避免儿童接受二次内镜检查带来的不适，仅建议对选定的高危病例进行二次内镜检查。
