A comparison of oral omeprazole and intravenous cimetidine in reducing complications of duodenal peptic ulcer.
BACKGROUND
Gastrointestinal bleeding is a common problem and its most common etiology is peptic ulcer disease. Ulcer rebleeding is considered a perilous complication for patients. To reduce the rate of rebleeding and to fasten the improvement of patients' general conditions, most emergency departments in Iran use H2-blockers before endoscopic procedures (i.e. intravenous omeprazole is not available in Iran). The aim of this study was to compare therapeutic effects of oral omeprazole and intravenous cimetidine on reducing rebleeding rates, duration of hospitalization, and the need for blood transfusion in duodenal ulcer patients.


METHODS
In this clinical trial, 80 patients with upper gastrointestinal bleeding due to duodenal peptic ulcer and endoscopic evidence of rebleeding referring to emergency departments of Imam and Sina hospitals in Tabriz, Iran were randomly assigned to two equal groups; one was treated with intravenous cimetidine 800 mg per day and the other, with 40 mg oral omeprazole per day.


RESULTS
No statistically significant difference was found between cimetidine and omeprazole groups in regards to sex, age, alcohol consumption, cigarette smoking, NSAID consumption, endoscopic evidence of rebleeding, mean hemoglobin and mean BUN levels on admission, duration of hospitalization and the mean time of rebleeding. However, the need for blood transfusion was much lower in omeprazole than in cimetidine group (mean: 1.68 versus 3.58 units, respectively; p < 0.003). Moreover, rebleeding rate was significantly lower in omeprazole group (15%) than in cimetidine group (50%) (p < 0.001).


CONCLUSIONS
This study demonstrated that oral omeprazole significantly excels intravenous cimetidine in reducing the need for blood transfusion and lowering rebleeding rates in patients with upper gastrointestinal bleeding. Though not statistically significant (p = 0.074), shorter periods of hospitalization were found for omeprazole group which merits consideration for cost minimization.
Khoshbaten
Manouchehr
M
Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. mkhoshbaten@yahoo.com
Fattahi
Ebrahim
E
Naderi
Nosratollah
N
Khaleghian
Farzaneh
F
Rezailashkajani
Mohammadreza
M
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002927:Cimetidine / Q000008:administration & dosage* / Q000627:therapeutic use; D004381:Duodenal Ulcer / Q000150:complications / Q000188:drug therapy*; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000473:pathology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage* / Q000627:therapeutic use; D055502:Secondary Prevention
D000897:Anti-Ulcer Agents; D002927:Cimetidine; D009853:Omeprazole