Continuous infusion of high-dose omeprazole is more effective than standard-dose omeprazole in patients with high-risk peptic ulcer bleeding: a retrospective study.
High-dose omeprazole reduces the rate of recurrent bleeding after endoscopic treatment of peptic ulcer bleeding. However, the effectiveness of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding has never been shown.


OBJECTIVE
To compare the benefits of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding.


METHODS
We reviewed the medical files of patients admitted between 1997 and 2004 for high-risk peptic ulcer bleeding who had undergone successful endoscopic treatment. We distinguished 2 periods: before 2001, standard-dose omeprazole (40 mg/day intravenously until alimentation was possible, then 40 mg/day orally for 1 week); after 2001, high-dose omeprazole (80 mg bolus injection, then 8 mg/h continuous infusion for 72 h, then 40 mg/day orally for 1 week). During both periods, patients subsequently received omeprazole, 20 mg/day, orally for 3 weeks.


RESULTS
We enrolled 114 patients (period 1, n = 45, period 2, n = 69). Therapy with high-dose omeprazole significantly decreased the occurrence of poor outcome (27 vs. 12%, P = 0.04), rebleeding (24 vs. 7%, P = 0.01), mortality due to haemorrhagic shock (11 vs. 0%, P < 0.001) and need for surgery (9 vs. 1%, P = 0.05).


CONCLUSIONS
In this retrospective study, high-dose omeprazole reduced the occurrence of rebleeding, need for surgery and mortality due to hemorrhagic shock in patients with high-risk peptic ulcer bleeding, as compared with standard-dose omeprazole.
Simon-Rudler
M
M
Service d'Hépatologie et de Gastroentérologie, Hôpital Pitié-Salpêtrière AP-HP, Paris, France.
Massard
J
J
Bernard-Chabert
B
B
DI Martino
V
V
Ratziu
V
V
Poynard
T
T
Thabut
D
D
D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001803:Blood Transfusion; D004305:Dose-Response Relationship, Drug; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage*; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control* / Q000601:surgery; D054328:Proton Pump Inhibitors; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012771:Shock, Hemorrhagic / Q000517:prevention & control*; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D009853:Omeprazole