title: Use of omeprazole in the management of giant duodenal ulcer: results of a prospective study.
abstract: BACKGROUND
  Giant duodenal ulcer (GDU) is generally thought to require surgical intervention. Proton pump inhibitors have beneficial effects in peptic ulcer disease, but their role in GDU disease is unknown. We examined the use of omeprazole in GDU management.
  
  
  METHODS
  Twenty-eight patients were diagnosed with GDU. One patient required immediate operative intervention. The remaining 27 were placed on omeprazole (40 mg daily). When ulcer healing was documented by endoscopy, the patients were placed on oral histamine-2 receptor antagonist therapy.
  
  
  RESULTS
  Of the 28 study patients, 20 (71.4%) did not require operative intervention, and 8 (28.6%) required operation for ulcer complications. Of the 15 patients with adherent clot or a visible vessel at initial endoscopy, 7 (46.7%) required operative intervention, as compared with 1 (7.7%) of the 13 patients without a visible vessel or adherent clot. This difference was statistically significant (P < .05). Twenty-three patients underwent antral biopsy and/or enzyme-linked immunosorbent assay for Helicobacter pylori, and 9 (39.1%) had a positive result.
  
  
  CONCLUSIONS
  Omeprazole is effective in the treatment of GDU disease. An adherent clot or a visible vessel at endoscopy indicates a higher likelihood of complications requiring operation. The relatively low H pylori infection rate, as compared with other peptic ulcer disease, may indicate a different pathophysiology in GDU.
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Ohio, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Fischer
authors.forename: M S
authors.initials: MS
authors.lastname: Nussbaum
authors.forename: T A
authors.initials: TA
authors.lastname: Pritts
authors.forename: N H
authors.initials: NH
authors.lastname: Gilinsky
authors.forename: R E
authors.initials: RE
authors.lastname: Weesner
authors.forename: S P
authors.initials: SP
authors.lastname: Martin
authors.forename: R A
authors.initials: RA
authors.lastname: Giannella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001706:Biopsy; D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents; D009853:Omeprazole