Role of intravenous omeprazole in patients with high-risk peptic ulcer bleeding after successful endoscopic epinephrine injection: a prospective randomized comparative trial.
BACKGROUND
Epinephrine injection is the most common endoscopic therapy for peptic ulcer bleeding. Controversy exists concerning the optimal dose of proton pump inhibitors (PPI) for patients with bleeding peptic ulcers after successful endoscopic therapy. The objective of this study was to determine the optimal dose of PPI after successful endoscopic epinephrine injection in patients with bleeding peptic ulcers.


METHODS
A total of 200 peptic ulcer patients with active bleeding or nonbleeding visible vessels (NBVV) who had obtained initial hemostasis with endoscopic injection of epinephrine were randomized to receive omeprazole 40 mg infusion every 6 h, omeprazole 40 mg infusion every 12 h or cimetidine (CIM) 400 mg infusion every 12 h. Outcomes were checked at 14 days after enrollment.


RESULTS
Rebleeding episodes were fewer in the group with omeprazole 40 mg infusion every 6 h (6/67, 9%) as compared with that of the CIM infusion group (22/67, 32.8%, p < 0.01). The volume of blood transfusion was less in the group with omeprazole 40 mg every 6 h than in those groups with omepraole 40 mg infusion every 12 h (p= 0.001) and CIM 400 mg infusion every 12 h (p < 0.001). The hospital stay, number of patients requiring urgent operation, and death rate were not statistically different among the three groups.


CONCLUSIONS
A combination of endoscopic epinephrine injection and a large dose of omeprazole infusion is superior to combined endoscopic epinephrine injection with CIM infusion for preventing recurrent bleeding from peptic ulcers with active bleeding or NBVV.
Division of Gastroenterology, Department of Medicine, VGH-TAIPEI, Sec. 2 Shih-Pai Road, Taipei 11217, Taiwan.
Hwai-Jeng
HJ
Lin
Wen-Ching
WC
Lo
Yang-Chih
YC
Cheng
Chin-Lin
CL
Perng
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001803:Blood Transfusion; D002927:Cimetidine / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004564:Electrocoagulation; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005773:Gastroscopy; D006801:Humans; D007262:Infusions, Intravenous; D015552:Injections, Intralesional; D008297:Male; D009853:Omeprazole / Q000008:administration & dosage*; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012008:Recurrence; D012307:Risk Factors
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D002927:Cimetidine; D009853:Omeprazole; D004837:Epinephrine