At present the optimal treatment strategy to prevent rebleeding of ulcers with nonbleeding visible vessels and adherent clots is unclear.
Dr Joseph Sung and colleagues at the Prince of Wales Hospital, Hong Kong, compared intravenous omeprazole infusion plus endoscopic therapy with intravenous omeprazole infusion for the treatment of such ulcers.
156 persons with upper gastrointestinal bleeding and ulcers showing nonbleeding visible vessels or adherent clots were randomized to receive omeprazole either with or without endoscopic therapy.
Ulcer bleeding recurred before discharge in 7 patients (9%) who received intravenous omeprazole alone compared to 0 patients who received combined endoscopic and omeprazole therapy.
The probability of recurrent bleeding within 30 days was 11.6% in patients who received omeprazole alone and 1.1% in patients with combined therapy.
Less blood transfusion was required by patients in the combined therapy group.
4 patients receiving omeprazole alone (5.1%) and 2 patients receiving combined therapy (2.6%) died within 30 days.
| Recurrent bleeding occurred in 11.6% of patients on omeprazole alone and in 1.1% of patients who also received endoscopic therapy.|
|Annals of Internal Medicine|
Dr Sung concludes, “The combination of endoscopic therapy and omeprazole infusion is superior to omeprazole infusion alone.”