Role of intravenous omeprazole in patients with high-risk peptic ulcer bleeding after successful endoscopic epinephrine injection

A prospective randomized comparative trial

Hwai Jeng Lin, Wen Ching Lo, Yang Chih Cheng, Chin Lin Perng

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

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. CONCLUSION: 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.

Original languageEnglish
Pages (from-to)500-505
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume101
Issue number3
DOIs
Publication statusPublished - Mar 2006
Externally publishedYes

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Omeprazole
Peptic Ulcer
Epinephrine
Cimetidine
Hemorrhage
Injections
Proton Pump Inhibitors
Endoscopic Hemostasis
Blood Transfusion
Length of Stay
Mortality
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Role of intravenous omeprazole in patients with high-risk peptic ulcer bleeding after successful endoscopic epinephrine injection : A prospective randomized comparative trial. / Lin, Hwai Jeng; Lo, Wen Ching; Cheng, Yang Chih; Perng, Chin Lin.

In: American Journal of Gastroenterology, Vol. 101, No. 3, 03.2006, p. 500-505.

Research output: Contribution to journalArticle

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abstract = "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. CONCLUSION: 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.",
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