Effect of intragastric pH on control of peptic ulcer bleeding.
BACKGROUND
We have performed series studies to investigate the effect of intragastric pH on control of peptic ulcer bleeding. In laboratory and animal studies, both platelet aggregation and gastric mucosal bleeding time were shown to be extremely sensitive to different pH levels. Platelet aggregation decreased significantly at pH > or = 6.8 and gastric mucosal bleeding time fell significantly at pH > or = 6.4. In a prospective clinical trial, primed infusions of different dosages of omeprazole (8 or 4 mg/h) after a bolus (40 mg) produced consistently high intragastric pH values in patients with bleeding duodenal ulcer. These results were not significantly different from that obtained from omeprazole 40 mg bolus treatment every 12 h (P > 0.05). However, primed injection with cimetidine (800 mg/12 h) was less effective (P < 0.05).


METHODS
In a retrospective analysis, 303 patients with bleeding peptic ulcer who were treated with cimetidine and 326 patients who were treated with omeprazole were compared.


RESULTS
The emergency surgery (4.91%) and mortality rates (1.84%) in the omeprazole group were not significantly different (P > 0.05) from those (7.28 and 1.99%) in the cimetidine group. However, the standardized emergency surgery rate of the omeprazole group (3.28%) was significantly lower than that (9.28%) of the cimetidine group (P < 0.05).


CONCLUSIONS
We conclude that increased intragastric pH to at least 6.4 with omeprazole is helpful in controlling peptic ulcer bleeding. Chinese patients require a lower dose of omeprazole than their Western counterparts to control ulcer bleeding.
Li
Y
Y
Department of Gastroenterology, First Municipal Hospital of Guangzhou, China.
Sha
W
W
Nie
Y
Y
Wu
H
H
She
Q
Q
Dai
S
S
Jia
L
L
Yu
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002927:Cimetidine / Q000627:therapeutic use*; D004381:Duodenal Ulcer / Q000150:complications*; D005260:Female; D005744:Gastric Acid; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000503:physiopathology*; D010974:Platelet Aggregation; D051381:Rats; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000150:complications*
D000897:Anti-Ulcer Agents; D002927:Cimetidine; D009853:Omeprazole