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High dose omeprazole heals pancreatic fistula; A case series


Abstract

Introduction:Pancreatic fistula is a serious complication after pancreatic and peripancreatic organ surgery. No clear management modality is fool proof. Increased Gastrin level is known to reduce Secretin. Omeprazole is the first proton pump inhibitor and in use since in the last 40years. Thus, a high dose of Omeprazole is likely to suppress the Secretin and likely to reduce the fistula output and thus improve the healing.

Materials and methods: Confirmed pancreatic fistula patients as defined by an international consensus group were included in this prospective study. Patients with ascites and fistula healing in five days were excluded. Bacterial culture positive drain fluid patients were not excluded. All received 60mg of Omeprazole 12hourly and continued for 2months after the closure of fistula. The drain fluid volumes were measured daily and amylase periodically during the follow up.

Result:There were 39 cases in 13years (2005 to 2017) with 35 males and 4 females. All the fistulae closed in 7-24days (mean 11.777 SD +/- 3.882). One case developed a pseudocyst after early stoppage of Omeprazole, but it, resolved with another course. Second, end PF required elective fistulo-enterostomy for recurrent fistula. 

Conclusion: High dose Omeprazole hastens up the healing of pancreatic fistula. Further studies are needed.

Keywords

pancreatic fistula, high dose Omeprazole, open main pancreatic duct. Postoperative pancreatic fistula, end duct fistula

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