Regular-dose versus high-dose omeprazole in peptic ulcer bleeding: a prospective randomized double-blind study

Area of Science:

• Gastroenterology
• Pharmacology

Background:

• Peptic ulcer bleeding is a significant cause of mortality.
• Acid inhibition and endoscopic therapy are crucial for managing peptic ulcer bleeding.
• The optimal omeprazole dosage for preventing rebleeding requires further investigation.

Purpose of the Study:

• To evaluate the equivalence of a high-dose versus a regular-dose omeprazole regimen in preventing rebleeding in patients with acute peptic ulcer bleeding.
• To compare the efficacy of different omeprazole doses in reducing the need for surgery and mortality rates.

Main Methods:

• A prospective, randomized, double-blind study was conducted with 142 patients experiencing acute peptic ulcer bleeding (Forrest classification I-II).
• Patients received either a regular intravenous dose (20 mg/day for 3 days) or a high-dose (80 mg bolus + 8 mg/h for 3 days) of omeprazole.
• Endoscopic treatment was administered to 71.8% of patients prior to randomization.

Main Results:

• Rebleeding rates were 8.2% for the regular dose and 11.6% for the high dose (P = 0.002 for equivalence).
• Surgery rates were 4.1% for the regular dose and 7.2% for the high dose.
• 30-day mortality rates were 5.5% for the regular dose and 2.9% for the high dose.

Conclusions:

• The regular dose of omeprazole demonstrated equivalence to the high dose in preventing peptic ulcer rebleeding within the defined tolerance limits.
• These findings suggest that a standard omeprazole regimen is sufficient for managing acute peptic ulcer bleeding.
• The study supports the use of regular-dose omeprazole in conjunction with endoscopic therapy for peptic ulcer bleeding management.