[When should patients with bleeding peptic ulcer resume oral intake? A randomized controlled study].
OBJECTIVE
Patients presenting with bleeding peptic ulcers are often kept fasted. The contribution of feeding in bleeding recurrence rate is unknown. The aim of this prospective controlled study was to evaluate the effect of early feeding in (a) the bleeding peptic ulcer recurrence rate and (b) the outcome of patients with severe bleeding peptic ulcer.


METHODS
From January through December 1995, all consecutive patients admitted for active bleeding from peptic ulcer were included. All patients underwent emergency endoscopic injection with adrenaline around and into the base of the ulcer and were randomized in two groups. Group A patients (n = 12) received milk on day 1, mixed warm feeding on day 2 and normal diet from day 3, Group B patients (n = 14) were nil by mouth until day 3, then received milk on day 4, mixed warm feeding on day 5, and normal diet from day 6. Twenty-six patients (17 men, 9 women, mean age 71 years) were included.


RESULTS
On day 0, both groups (group A vs group B) were comparable (mean +/- SD): hemoglobin (8.8 +/- 2.7 vs 8.1 +/- 2.0 g/dL), transfusion requirements in the first 24 h after admission (2.2 +/- 2.0 vs 2.1 +/- 1.4 units), localization of ulcers (duodenal ulcer: 8 vs 9, gastric ulcer : 4 vs 5). There were no significant differences in group A and group B for bleeding ulcer recurrence rate (0 vs 1 patient) and transfusion requirements (2.6 +/- 2.1 vs 3.3 +/- 2.1 units). Hospital stay was significantly shorter in group A (6.8 +/- 2.1 days) than in group B (9.9 +/- 3.7 days), P = 0.01.


CONCLUSIONS
These results did not provide any evidence of advantages of fasting in patients with active bleeding peptic ulcer treated by endoscopic sclerotherapy. Early feeding did not worsen outcome in patients with active bleeding peptic ulcer and reduced hospital stay.
Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpital Jean-Bernard, Poitiers.
V
V
de Lédinghen
P
P
Beau
P R
PR
Mannant
M P
MP
Ripault
C
C
Borderie
C
C
Silvain
M
M
Morichau-Beauchant
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D004435:Eating; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005215:Fasting; D005260:Female; D005773:Gastroscopy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008892:Milk; D010438:Peptic Ulcer Hemorrhage / Q000178:diet therapy* / Q000188:drug therapy; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D004837:Epinephrine
Quand faut-il reprendre l'alimentation orale après hémorragie ulcéreuse gastro-duodénale? Etude contrôlée randomisée.