Seven-day intravenous low-dose omeprazole infusion reduces peptic ulcer rebleeding for patients with comorbidities

• Published in: Gastrointestinal endoscopy Vol. 70; no. 3; pp. 433 - 439
• Main Authors: Cheng, Hsiu-Chi, MD, Chang, Wei-Lun, MD, Yeh, Yi-Chun, MS, Chen, Wei-Ying, MD, Tsai, Yu-Ching, MD, Sheu, Bor-Shyang, MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.09.2009; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Comorbidity; Confidence Intervals; Digestive system; Digestive system. Abdomen; Dose-Response Relationship, Drug; Drug Administration Schedule; Duodenal Ulcer - diagnosis; Duodenal Ulcer - drug therapy; Duodenal Ulcer - epidemiology; Education, Medical, Continuing; Endoscopy; Esomeprazole; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Hemostasis, Endoscopic - methods; Humans; Infusions, Intravenous; Investigative techniques, diagnostic techniques (general aspects); Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Omeprazole - administration & dosage; Other diseases. Semiology; Peptic Ulcer Hemorrhage - diagnosis; Peptic Ulcer Hemorrhage - drug therapy; Peptic Ulcer Hemorrhage - epidemiology; Pharmacology. Drug treatments; Probability; Prospective Studies; Risk Assessment; Secondary Prevention; Severity of Illness Index; Statistics, Nonparametric; Stomach Ulcer - diagnosis; Stomach Ulcer - drug therapy; Stomach Ulcer - epidemiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Rate; Time Factors; Treatment Outcome; aPTT; intravenous; activated partial thromboplastin time; SRH; American Society of Anesthesiologists; Hb; ICU; intensive care unit; stigmata of recent hemorrhage; IV; hemoglobin; ASA; Human; Relapse; Intravenous administration; Enzyme; Low dose; H; Enzyme inhibitor; Peptic ulcer; Antiulcer agent; K; Proton pump inhibitor; Omeprazole; Gastroduodenal; Benzimidazole derivatives; Antisecretory agent; exchanging ATPase; Hydrolases; Digestive diseases; Intestinal disease; Gastric disease
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2009.01.041

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. Design A prospective randomized control study. Setting National Cheng Kung University, Tainan, Taiwan. Patients A total of 147 patients with comorbidities and peptic ulcer bleeding controlled by endoscopic hemostasis were enrolled. Interventions 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. Main Outcome Measurements 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.