Related Experiment Videos
High-Dose Oral Omeprazole Versus Continuous Intravenous Pantoprazole in Patients With High-Risk Peptic Ulcer
Kanteera Sriyudthsak1, Nutbordee Nalinthassanai2, Bunyos Sriapiraksa3
1Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.
Background And Aim:
The efficacy of high-dose oral omeprazole in peptic ulcer bleeding after successful therapeutic hemostatic endoscopy has not been well established. This study aimed to compare the efficacy of high-dose oral omeprazole versus continuous intravenous (IV) pantoprazole in rebleeding and percent time of gastric pH above 6.
Methods:
Eligible patients were randomized with 1:1 concealed allocation to 40-mg oral omeprazole twice daily or IV pantoprazole 8 mg/h for 72 h after index gastroscopy. Gastric pH was measured for 24 h during 48-72 h after starting the assigned medication. Rebleeding at 72 h and 30 days, as well as 24-h gastric pH, were assessed.
Results:
A total of 124 patients were analyzed. Seventy-two-hour rebleeding occurred in 1.6% (1/61) of the oral omeprazole group and 4.8% (3/63) of the IV pantoprazole group requiring endoscopic hemostasis (risk difference [RD] -3.1%, 95% CI -11.6% to 4.6%). Rebleeding within 30 days also showed no difference between groups (3.3% vs. 4.8%, RD -1.5%, 95% CI -10.1% to 7.0%). Gastric pH monitoring was completed in 48% (29/61) of the oral group and 41% (26/63) of the IV group. The median percentage of gastric pH > 6 was 56.3% (IQR 28.0%-92.0%) in the oral group and 27.3% (IQR 4.4%-77.7%) in the IV group (p = 0.064).
Conclusions:
High-dose oral omeprazole may represent a feasible alternative to continuous IV pantoprazole in terms of preventing rebleeding at 72 h and 30 days and maintaining gastric pH > 6 among patients with peptic ulcer bleeding who underwent successful therapeutic hemostatic endoscopy.
Trial Registration:
Registration number: NCT04394663.
Related Concept Videos
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
01:13Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...
01:30Peptic Ulcer Disease I: Introduction
An acute ulcer, marked by superficial erosion and minimal inflammation, swiftly resolves upon identifying and addressing the underlying cause. In contrast, a chronic ulcer persists, potentially eroding through the muscular wall and forming fibrous tissue.
Peptic ulcers can also be...
01:25Peptic Ulcer Disease I: Introduction
01:20Drugs for Peptic Ulcer Disease: Prostaglandin Analogs as Mucosal Protective Agents
Non-steroidal anti-inflammatory drugs (NSAIDs) can induce peptic ulcers by inhibiting cyclooxygenase, decreasing...
01:24Drugs for Peptic Ulcer Disease: Sucralfate as Mucosal Protective Agents
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...