title: Late-onset life threatening hemorrhage of omeprazole-resistant duodenal ulcer managed by interventional radiology: report of a case.
abstract: A 67-year-old diabetic man was emergently hospitalized in our department because of a huge duodenal ulcer without visible vessels. Despite of intravenous administration of 40 mg omeprazole and fasting with intravenous nutritional support, endoscopically unmanageable massive bleeding occurred on the 8th hospital day. Emergent angiography showed extravasation of contrast media from a duodenal branch of the proper hepatic artery, and superselective arterial embolization was successfully achieved. The patient recovered from the hemorrhagic shock and underwent subsequent successful surgery. Analysis of CYP2C19 enzyme genotype indicated the patient was a homozygous extensive metabolizer, considered a poor responder for omeprazole treatment.
authors.affiliation: Department of Internal Medicine, Kyushu Central Hospital.
authors.forename: Kazuoki
authors.initials: K
authors.lastname: Hizawa
authors.forename: Nobutoshi
authors.initials: N
authors.lastname: Miura
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitamura
authors.forename: Mari
authors.initials: M
authors.lastname: Nakamori
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Iida
mesh_terms: D000368:Aged; D000792:Angiography; D000897:Anti-Ulcer Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D065731:Cytochrome P-450 CYP2C19; D004351:Drug Resistance / Q000502:physiology*; D004381:Duodenal Ulcer / Q000150:complications* / Q000188:drug therapy* / Q000235:genetics / Q000601:surgery; D004621:Embolization, Therapeutic; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006720:Homozygote; D006801:Humans; D008297:Male; D006899:Mixed Function Oxygenases / Q000235:genetics; D009853:Omeprazole / Q000494:pharmacology* / Q000627:therapeutic use; D011110:Polymorphism, Genetic; D015642:Radiology, Interventional / Q000379:methods*
chemical_list: D000897:Anti-Ulcer Agents; D006899:Mixed Function Oxygenases; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D009853:Omeprazole