title: Hydrogen peroxide improves the visibility of ulcer bases in acute non-variceal upper gastrointestinal bleeding: a single-center prospective study.
abstract: BACKGROUND
  Acute non-variceal upper gastrointestinal bleeding (ANVB) or hemorrhage (used interchangeably) is an emergency. Endoscopically applied hydrogen peroxide (H2O2) has been shown to improve visualization of the ulcer base.
  
  
  OBJECTIVE
  To test the hypothesis that ulcer base clot clearance with 3% H2O2 improves the visualization of ANVB lesions compared to water alone.
  
  
  METHODS
  In this single-center prospective study, 320 patients with ANVB were examined, of which 81 met the entry criteria for evaluation. All patients with ANVB underwent urgent endoscopy. Those with adherent clots on the ulcer base were sprayed with 250 ml of water, followed by up to 100 ml of 3% H2O2. The main outcome measurement was Kalloo"s Visual Scores of the ulcer base before and after water and H2O2.
  
  
  RESULTS
  Eighty-one patients with gastric ulcers (GU; 34) and duodenal ulcers (DU; 47) met the entry criteria. The mean improvement in grade from water to H2O2 was 2.04 (95% confidence interval [CI] (1.86, 2.23)). The mean volume of H2O2 used to clear clots was higher (70 ml) in patients who were negative for both Helicobacter pylori and non-steroidal anti-inflammatory drug (NSAID) use than in those who were positive for both (31 ml) (P = 0.00). More DU patients (72%) had visible vessels than GU patients (44%) (P = 0.01).
  
  
  CONCLUSIONS
  H2O2 improved the visualization of ulcer bases in ANVB. A smaller volume of H2O2 was required to clear clots in patients who used NSAIDs and had H. pylori infection. H2O2 identified more DU vessels. The use of H2O2 should be considered as a standard therapy in the management of clots in ANVB.
authors.affiliation: Section of Gastroenterology and Hepatology, Medical College of Georgia, Augusta, GA, USA. ssridhar@mcg.edu
authors.forename: Subbaramiah
authors.initials: S
authors.lastname: Sridhar
authors.forename: Sherman
authors.initials: S
authors.lastname: Chamberlain
authors.forename: Dharma
authors.initials: D
authors.lastname: Thiruvaiyaru
authors.forename: Sankara
authors.initials: S
authors.lastname: Sethuraman
authors.forename: Jigneshkumar
authors.initials: J
authors.lastname: Patel
authors.forename: Moonkyung
authors.initials: M
authors.lastname: Schubert
authors.forename: Francisco
authors.initials: F
authors.lastname: Cuartas-Hoyos
authors.forename: Robert
authors.initials: R
authors.lastname: Schade
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D006861:Hydrogen Peroxide; D008297:Male; D008875:Middle Aged; D016877:Oxidants; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D016877:Oxidants; D006861:Hydrogen Peroxide