Orally administered omeprazole versus injection therapy in the prevention of rebleeding from peptic ulcer with visible vessel. A multicenter randomized study.

ABSTRACT

Endoscopic injection therapy significantly reduces the risk of bleeding relapse in patients with digestive hemorrhage due to peptic ulcers associated with a visible vessel. Profound and sustained acid inhibition by proton pump inhibitors may generate optimal conditions for clotting and prevent bleeding relapse. Over a one-year period, 52 patients presenting with digestive hemorrhage, in whom emergency endoscopy showed a peptic ulcer with a non-bleeding visible vessel, were enrolled in a multicenter randomized study comparing oral omeprazole, 40 mg per day (n = 31) vs adrenaline (110,000) plus polidocanol (1%) injection associated with oral ranitidine 300 mg per day (n = 21). Rebleeding occurred in 15/52 (29%) patients 8/31 (26%) in the omeprazole group with 6 major hemorrhages (19%), and in 7/21 (33%) in the injection group with 3 major hemorrhages (14%); the differences were not significant. No difference was observed between omeprazole and injection group in terms of volume of transfused blood (2.03 +/- 1.5 vs 3.1 +/- 0.9 blood units), need for hemostatic surgery (9.6% vs 14.3%), mortality (19.3% vs 14.3%) and mean hospital stay (11.5 days both groups). This study suggests that oral omeprazole, 40 mg per day, has an efficacy comparable to injection therapy in reducing the bleeding relapse from non bleeding peptic ulcers associated with visible vessel.