Bolus intravenous omeprazole B.I.D. vs. continuous intravenous omeprazole infusion combined with endoscopic hemostasis in the treatment of peptic ulcer bleeding. Preliminary results

INTRODUCTION: The mainstay of manageming patients with peptic ulcer bleeding (PUB) is endoscopic hemostasis, coupled with medical treatment i.e. fluid resuscitation, transfusion and antacids. Proton pump inhibitors (PPIs) are the most potent antacids and current data support that large, continuous doses yield maximal acid suppression. AIMS & METHODS: To evaluate the outcome of patients with (PUB) treated with bolus or continuous intravenous administration of omeprazole in conjunction with endoscopic hemostasis. All patients presenting with PUB were prospectively randomized to either bolus intravenous omeprazole 40 mg b.i.d. (Group A: n=36), or continuous intravenous omeprazole infusion 160 mg/24h after a loading dose of 80 mg omeprazole bolus IV (Group B: n=40). All patients underwent EGD in either an emergent or scheduled setting, according to their clinical status, during the first 24 hours of admission. Patients with malignant gastric ulcers were not included in this study as were patients with bleeding of non peptic ulcer origin. Endoscopic hemostasis was performed in Forrest I, IIa, and IIb lesions. The endoscopist during the examination was the judge of the hemostatic means employed on each patient. Data collected included age, gender, smoking and drinking habits, Helicobacter Pylori infection, NSAIDs and/or aspirin prior use, hospital stay, number of transfusions, and the need for surgical intervention and death. RESULTS: Endoscopic hemostasis was performed on 14 patients in Group A (38.9%) and on 10 patients in Group B (25%), by means of adrenaline injection, endoclip placement and band ligation. Mean transfusions in Group A were 2.5 units whereas in Group B 3.25 units (p=0.9). Patients of Group A were hospitalized for a mean of 6.1±2.3 days while the length of hospital stay for Group B patients was 5.8±2.3 days (p=0.84). All other parameters studied (age, sex, smoking and drinking habits, Helicobacter Pylori infection, NSAIDs and/or aspirin prior use) presented no statistical differences. One patient of Group B was ultimately surgically treated, and self-limited bleeding relapse was observed on two Group-A patients, which was treated conservatively. No deaths occurred. CONCLUSION: Both regimens proved equally effective in the treatment of PUB. More clinical trials are needed in order to specify the appropriate PPI regimen for patients with PUB.