The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: a randomized comparison.
BACKGROUND
The optimal treatment of ulcers with nonbleeding visible vessels and adherent clots is unclear.


OBJECTIVE
To compare intravenous omeprazole infusion plus endoscopic therapy with intravenous omeprazole infusion alone for prevention of recurrent bleeding from ulcers with nonbleeding visible vessels or adherent clots.


METHODS
Single-blind randomized study with blinded evaluation of study end points.


METHODS
An endoscopy center in a university hospital in Hong Kong.


METHODS
156 persons with upper gastrointestinal bleeding and ulcers showing nonbleeding visible vessels or adherent clots.


METHODS
Combination of endoscopic therapy and omeprazole infusion versus sham endoscopic therapy and omeprazole infusion.


METHODS
Recurrent ulcer bleeding before discharge and within 30 days.


RESULTS
78 patients were recruited in each group. Ulcer bleeding recurred before discharge in seven patients who received intravenous omeprazole alone (9%) and no patients who received combined therapy (difference, 9 percentage points [95% CI, 1.7 to 17.6 percentage points]; P = 0.01). The probability of recurrent bleeding within 30 days was 11.6% (9 patients) in the omeprazole-alone group and 1.1% (1 patient) in the combined therapy group (difference, 10.5 percentage points [CI, 1.7 to 19.8 percentage points]; P = 0.009). Patients in the combined therapy group required less transfusion (difference in median units of blood transfused, 1 unit [CI, 0 to 2 units]; P = 0.02). One patient in the combined therapy group had surgery for ulcer perforation. Four patients receiving omeprazole alone (5.1%) and two patients receiving combined therapy (2.6%) died within 30 days.


CONCLUSIONS
The combination of endoscopic therapy and omeprazole infusion is superior to omeprazole infusion alone for preventing recurrent bleeding from ulcers with nonbleeding visible vessels and adherent clots.
Sung
Joseph J Y
JJ
Endoscopy Center, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong. joesung@cuhk.edu.hk
Chan
Francis K L
FK
Lau
James Y W
JY
Yung
Man-Yee
MY
Leung
Wai-Keung
WK
Wu
Justin C Y
JC
Ng
Enders K W
EK
Chung
S C Sydney
SC
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors; D012008:Recurrence; D016037:Single-Blind Method; D013276:Stomach Ulcer / Q000517:prevention & control / Q000628:therapy*; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D009853:Omeprazole