The Efficacy of High- and Low-Dose Intravenous Omeprazole in Preventing Rebleeding for Patients with Bleeding Peptic Ulcers and Comorbid Illnesses
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This study sought to determine if high-dose omeprazole infusion could improve the control of rebleeding in patients with comorbid illnesses and bleeding peptic ulcers. After achieving hemostasis by endoscopy, 105 patients were randomized into high-dose (n = 52) and low-dose (n = 53) groups, receiving 200 and 80 mg/day omeprazole, respectively, as a continuous infusion for 3 days.
Thereafter, oral omeprazole, 20 mg/day, was given. The cumulative rebleeding rates comparatively rose in both groups (high-dose vs. low-dose group), beginning on day 3 (15.4% vs. 11.3%), day 7 (19.6% vs. 20%), and day 14 (32.7% vs. 28.9%), until day 28 (35.4% vs. 33.3%), and were not significantly different between the two groups (P > 0.50). Multiple logistic regression confirmed that a serum albumin level < 3 g/dL was an independent factor associated with rebleeding (P = 0.002). For patients with comorbidities, 3-day omeprazole infusion, despite increasing the daily dose from 80 to 200 mg, was not adequate to control peptic ulcer rebleeding.
Key Wordspeptic ulcer bleeding comorbid illnesses omeprazole infusion hypoalbuminemia
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- 3.Jensen DM, Kovacs TOG, Randall GM, Machicado GA, Jensen ME, You S, Pelayo E: Prospective study of patients who developed severe ulcer bleeding as inpatients compared to outpatients. Gastrointest Endosc 38:235 (A38), 1992 (abstract)Google Scholar
- 6.Schaffalitzky de Muckadell OB, Havelund T, Harling H, Boesby S, Snel P, Vreeburg EM, Eriksson S, Fernström P, Hasselgren G: Effect of omeprazole on the outcome of endoscopically treated bleeding peptic ulcers: Randomized double-blind placebo-controlled multicentre study. Scand J Gastroenterol 32:320–327, 1997PubMedGoogle Scholar
- 7.Sheu BS, Chi CH, Huang CC, Kao AW, Wang YL, Yang HB: Impact of intravenous omeprazole on Helicobacter pylori eradication by triple therapy in patients with peptic ulcer bleeding. Aliment Pharmacol Ther 16:137–143, 2002Google Scholar
- 9.Bertilsson L: Geographic/interracial differences in polymorphic drug oxidation. Current state of knowledge of cytochromes P450 (CYP) 2D6 and 2C19. Clin Pharmacokinet 29:192–209, 1995Google Scholar
- 12.American Society of Anesthesiologists: New classification of physical status. Anesthesiology 24:111, 1963Google Scholar
- 13.Siringo S, Santoro P, Merighi S, Difebo G, McCormick PA, McIntyre N, Barbara L, Burroughs AK: Peptic ulceration and its complications in cirrhosis: an endoscopic and clinical survey in 2047 patients. Gut 31:A628, 1990 (abstract)Google Scholar
- 15.Cappell MS, Nadler SC: Increased mortality of acute upper gastrointestinal bleeding in patients with chronic obstructive pulmonary disease. A case controlled, multiyear study of 53 consecutive patients. Dig Dis Sci 40:256–262, 1995Google Scholar
- 18.Freston JW: Overview of medical therapy of peptic ulcer disease. Gastroenterol Clin North Am 9:121–140, 1990Google Scholar
- 20.Udd M, Miettinen P, Palmu A, Heikkinen M, Janatuinen E, Pasanen P, Tarvainen R, Kairaluoma MV, Lohman M, Mustonen H, Julkunen R: Regular-dose versus high-dose omeprazole in peptic ulcer bleeding: a prospective randomized double-blind study. Scand J Gastroenterol 36:1332–1338, 2001PubMedGoogle Scholar
- 23.Tarnawski A: Cellular mechanisms of gastric ulcer healing. In The Stomach. W Domschke, SJ Konturek (eds). Berlin, Springer-Verlag, 1993, pp 177–192Google Scholar
- 24.Tarnawski A: Cellular and molecular mechanisms of ulcer healing. Drugs Today 33:697–706, 1997Google Scholar