Prospective Randomized Trial for Optimal Prophylactic Treatment of the Upper Gastrointestinal Complications After Open Heart Surgery

• Published in: Circulation Journal Vol. 69; no. 3; pp. 331 - 334
• Main Authors: Hata, Mitsumasa, Shiono, Motomi, Sekino, Hisakuni, Furukawa, Hidekazu, Sezai, Akira, Iida, Mitsuru, Yoshitake, Isamu, Hattori, Tsutomu, Wakui, Sinji, Soeda, Masao, Taoka, Makoto, Negishi, Nanao, Sezai, Yukiyasu
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2005
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Ulcer Agents - administration & dosage; Benzimidazoles - administration & dosage; Cardiac Surgical Procedures - adverse effects; Diterpenes - administration & dosage; Endoscopy, Gastrointestinal; Gastritis - etiology; Gastritis - prevention & control; Gastrointestinal disease; Gastrointestinal Diseases - drug therapy; Gastrointestinal Diseases - etiology; Gastrointestinal Diseases - prevention & control; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - prevention & control; H2-recepter antagonist; Histamine H2 Antagonists - administration & dosage; Humans; Incidence; Omeprazole - administration & dosage; Omeprazole - analogs & derivatives; Open heart surgery; Postoperative Complications - drug therapy; Postoperative Complications - prevention & control; Premedication - methods; Proton pump inhibitor; Proton-Translocating ATPases - antagonists & inhibitors; Rabeprazole; Ranitidine - administration & dosage; Ulcer - etiology; Ulcer - prevention & control; Upper Gastrointestinal Tract
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.69.331

Background Upper gastrointestinal bleeding is a lethal complication after open heart surgery. We designed a prospective randomized trial to test the efficacy of different antisecretory agents to prevent upper gastrointestinal disease after operation. Methods and Results A total of 210 patients were divided into 3 groups: group I had 70 patients who had mucosal protection (teprenone 150 mg/day), group II had 70 patients who had histamine2-receptor antagonist (ranitidine 300 mg/day), and group III included 70 patients who had a proton pump inhibitor (rabeprazole 10 mg/day). Gastric fiberscopy was used in all patients postoperatively during days 5 to 7. We compared the 3 groups in terms of endoscopic findings. Four patients (5.7%) had gastric bleeding complications in each of groups I and II; 2 died of coagulopathy. In group III no patients had gastric bleeding. The incidence of hemorrhagic gastritis was significantly higher in groups I (22.9%) and II (15.7%) than in III (2.9%) (p=0.0003). The incidence of active ulcers was also significantly higher in groups I (28.6%) and II (21.4%) than in III (4.3%) (p=0.0001). Conclusions Early medication postoperative by a proton pump inhibitor was shown to be the most effective treatment and indeed might be described as mandatory to prevent upper gastrointestinal diseases after open heart surgery. (Circ J 2005; 69: 331 - 334)