Digestive Diseases and Sciences

, Volume 50, Issue 7, pp 1194–1201

The Efficacy of High- and Low-Dose Intravenous Omeprazole in Preventing Rebleeding for Patients with Bleeding Peptic Ulcers and Comorbid Illnesses

  • Hsiu-chi Cheng
  • Ai-wen Kao
  • Chiao-hsiung Chuang
  • Bor-shyang Sheu
Article

Abstract

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 Words

peptic ulcer bleeding comorbid illnesses omeprazole infusion hypoalbuminemia 

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References

  1. 1.
    Katschinski B, Logan R, Davies J, Faulkner G, Pearson J, Langman M: Prognostic factors in upper gastrointestinal bleeding. Dig Dis Sci 39:706–712, 1994PubMedGoogle Scholar
  2. 2.
    Yavorski RT, Wong RK, Maydonovitch C, Battin LS, Furnia A, Amundson DE: Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol 90:568–573, 1995PubMedGoogle Scholar
  3. 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
  4. 4.
    Terdiman JP, Ostroff JW: Gastrointestinal bleeding in the hospitalized patient: a case–control study to assess risk factors, causes, and outcome. Am J Med 104:349–354, 1998CrossRefPubMedGoogle Scholar
  5. 5.
    Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, Chan FK, Ng EK, You JH, Lee CW, Chan AC, Chung SC: Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med 343:310–316, 2000CrossRefPubMedGoogle Scholar
  6. 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. 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
  8. 8.
    Lam SK, Hasan M, Sircus W, Wong J, Ong GB, Prescott RJ: Comparison of maximal acid output and gastrin response to meals in Chinese and Scottish normal and duodenal ulcer subjects. Gut 21:324–328, 1980PubMedGoogle Scholar
  9. 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
  10. 10.
    Cheng HC, Chuang SA, Kao YH, Kao AW, Chuang CH, Sheu BS: Increased risk of rebleeding of peptic ulcer bleeding in patients with comorbid illness receiving omeprazole infusion. Hepatogastroenterology 50:2270–2273, 2003PubMedGoogle Scholar
  11. 11.
    Yang CC, Shin JS, Lin XZ, Hsu PI, Chen KW, Lin CY: The natural history (fading time) of stigmata of recent hemorrhage in peptic ulcer disease. Gastrointest Endosc 40:562–566, 1994PubMedGoogle Scholar
  12. 12.
    American Society of Anesthesiologists: New classification of physical status. Anesthesiology 24:111, 1963Google Scholar
  13. 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
  14. 14.
    Langman MJ, Cooke AR: Gastric and duodenal ulcer and their associated diseases. Lancet 1:680–683, 1976PubMedGoogle Scholar
  15. 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
  16. 16.
    Lightdale CJ, Kurtz RC, Sherlock P, Winawer SJ: Aggressive endoscopy in critically ill patients with upper gastrointestinal bleeding and cancer. Gastrointest Endosc 20:152–153, 1974PubMedGoogle Scholar
  17. 17.
    Tarnawski A, Stachura J, Krause WJ, Douglass TG, Gergely H: Quality of gastric ulcer healing: a new, emerging concept. J. Clin. Gastroenterol. 13:S42–S47, 1991PubMedGoogle Scholar
  18. 18.
    Freston JW: Overview of medical therapy of peptic ulcer disease. Gastroenterol Clin North Am 9:121–140, 1990Google Scholar
  19. 19.
    Laterre PF, Horsmans Y: Intravenous omeprazole in critically ill patients: a randomized, crossover study comparing 40 with 80 mg plus 8 mg/hour on intragastric pH. Crit Care Med 29:1931–1935, 2001PubMedGoogle Scholar
  20. 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
  21. 21.
    Martin P: Wound healing—Aiming for perfect skin regeneration. Science 276:75–81, 1997PubMedGoogle Scholar
  22. 22.
    Bennett NT, Schultz GS: Growth factors and wound healing: biochemical properties of growth factors and their receptors. Am J Surg 165:728–737, 1993PubMedGoogle Scholar
  23. 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. 24.
    Tarnawski A: Cellular and molecular mechanisms of ulcer healing. Drugs Today 33:697–706, 1997Google Scholar
  25. 25.
    Sung JJ, Chan FK, Lau JY, Yung MY, Leung WK, Wu JC, Ng EK, Chung SC: The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: a randomized comparison. Ann Intern Med 139:237–243, 2003PubMedGoogle Scholar
  26. 26.
    Lee KK, You JH, Wong IC, Kwong SK, Lau JY, Chan TY, Lau JT, Leung WY, Sung JJ, Chung SS: Cost-effectiveness analysis of high-dose omeprazole infusion as adjuvant therapy to endoscopic treatment of bleeding peptic ulcer. Gastrointest Endosc 57:160–164, 2003PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Hsiu-chi Cheng
    • 1
    • 2
  • Ai-wen Kao
    • 1
  • Chiao-hsiung Chuang
    • 1
  • Bor-shyang Sheu
    • 1
    • 2
    • 3
  1. 1.Department of Internal MedicineNational Cheng Kung University HospitalTainan
  2. 2.Institute of Clinical MedicineNational Cheng Kung University HospitalTainan
  3. 3.Department of Internal MedicineNational Cheng Kung University HospitalTainan

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