Recurrent bleeding of peptic ulcers after endoscopic treatment occurs in 15-20% of patients.
Dr James Lau and colleagues at the Chinese University of Hong Kong investigated whether administering intravenous omeprazole after initial endoscopic treatment would reduce the frequency of recurrent bleeding.
240 patients with actively bleeding ulcers, or ulcers with non-bleeding visible vessels, took part in the study.
Bleeds were initially treated endoscopically with an epinephrine injection followed by thermocoagulation.
After successful initial treatment, 120 patients received a bolus intravenous injection of 80mg omeprazole followed by an infusion of 8mg per hour for 3 days. The remaining 120 patients received placebo. All patients were given 20mg oral omeprazole daily for 8 weeks after the infusion.
After 30 days of follow up, bleeding recurred in 6.7% of the omeprazole group compared with 22.5% of the placebo group.
Surgery was required in 3 of the omeprazole group and nine of the placebo group. 4.2% of patients who received intravenous omeprazole died within 30 days of initial endoscopy compared with 10% of the placebo group.
The study provides strong evidence that widespread use of high-dose intravenous omeprazole should help to prevent many episodes of recurrent bleeding from peptic ulcers.
"A high-dose infusion of omeprazole substantially reduces the risk of recurrent bleeding."
Dr James Lau.
Writing in an editorial of this week's New England Journal of Medicine, Dr Eric Libby comments 'Endoscopic therapy consisting of thermocoagulation or injection of a hemostatic agent remains the most reliable treatment for bleeding peptic ulcers', agreeing that 'aggressive acid suppression with proton-pump inhibitors may further reduce the rate of recurrent bleeding'.
Currently, however, intravenous omeparazole and intravenous forms of other proton pump inhibitors are unavailable in the USA.