Seven-day intravenous low-dose omeprazole infusion reduces peptic ulcer rebleeding for patients with comorbidities.
BACKGROUND
Patients with comorbidities have an increased risk of ulcer rebleeding, especially within the 28 days after endoscopic therapy. Omeprazole infusion can prevent rebleeding after endoscopic therapy in patients with peptic ulcer bleeding. However, the optimal duration is uncertain, especially for those patients with comorbidities.


OBJECTIVE
To determine whether prolonged low-dose intravenous omeprazole could reduce rebleeding for patients with comorbidities.


METHODS
A prospective randomized control study.


METHODS
National Cheng Kung University, Tainan, Taiwan.


METHODS
A total of 147 patients with comorbidities and peptic ulcer bleeding controlled by endoscopic hemostasis were enrolled.


METHODS
The enrolled patients were randomized into either the 7-day low-dose group or the 3-day high-dose group, who received 3.3 mg/h or 8 mg/h continuous omeprazole infusion, respectively. After omeprazole infusion, oral esomeprazole 40 mg every day was given.


METHODS
To compare the rebleeding rates within 28 days after gastroscopy between the 2 study groups.


RESULTS
The 7-day cumulative rebleeding rate was similar between the 2 groups (9.5% vs 9.7%, P > .05), but the 7-day low-dose group had a lower risk of rebleeding between the 8th and 28th day compared with the 3-day high-dose group (0% vs 10.7%, P = .03; relative risk, 0.52 [95% CI, 0.43-0.63]). The Kaplan-Meier curves confirmed that the 7-day low-dose group had a significantly higher cumulative rebleeding-free proportion between the 8th and 28th day than the 3-day high-dose group (P = .02, log-rank test).


CONCLUSIONS
In Asian patients, prolonged low-dose omeprazole infusion for 7 days may reduce peptic ulcer rebleeding during the first 28 days in patients with comorbidities.
Cheng
Hsiu-Chi
HC
Institute of Clinical Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan.
Chang
Wei-Lun
WL
Yeh
Yi-Chun
YC
Chen
Wei-Ying
WY
Tsai
Yu-Ching
YC
Sheu
Bor-Shyang
BS
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D004502:Education, Medical, Continuing; D064098:Esomeprazole; D005260:Female; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage*; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013276:Stomach Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D009853:Omeprazole; D064098:Esomeprazole