Poor responders to intravenous omeprazole in patients with peptic ulcer bleeding

Although proton pump inhibitors are highly effective in raising intragastric pH, there still remains a small group of patients who resist acid suppression. A high dose of omeprazole has been shown to reduce rebleeding rate in patients with bleeding peptic ulcers after endoscopic therapy. The primary objective of this study was to assess the incidence of peptic ulcer bleeding patients who were resistant to intravenous omeprazole. The secondary objective was to evaluate the relationship between intragastric pH and rebleeding rate in studied patients after successful endoscopic therapy.

Between Oct. 1996 and Aug. 1999, 88 bleeding peptic ulcer patients who had obtained initial hemostasis with endoscopic therapy were enrolled in this study. In these patients, 40 mg of omeprazole was given as intravenous bolus followed by 40 mg intravenously every 6 h for 3 days. Thereafter, omeprazole was given 20 mg orally once daily for 2 months. The intragastric pH was recorded for 24 hours after the first dose of omeprazole. The occurrence of rebleeding was observed for 14 days.

The mean intragastric pH value of these 88 patients was 6.07, (95% CI: 5.91-6.23). Four patients (5%) were found to have omeprazole resistance (pH < 4.0, 50% of the time). By the 3rd days after entering the study, more patients with a mean pH < 6 rebled (5/25 vs. 3/63, p<0.05).

About five percent of patients with peptic ulcer bleeding respond poorly to intravenous omeprazole. Rebleeding rate is higher in patients with a mean intragastric pH of less than 6.