Intravenous anti-helicobacter therapy in helicobacter-positive bleeding peptic ulcer with major stigmata of recent hemorrhage: A preliminary report

Abstract

Aims: Eradication of H pylori significantly reduces the rate of ulcer rebleeding. Anti-Hp therapy should be considered in all H pylori-positive patients with ulcer bleeding to reduce the possibility of rebleeding. The aim of the present study was to examine the effect of intravenous route of dual therapy in active ulcer bleeding. Methods: In the prospective study, one hundred and thirty two patients with endoscopy documented ulcer bleeding with major stigmata of recent hemorrhage (active bleeding or non-bleeding visible vessel) were entered. Endoscopic injection therapy was performed in all patients with a mean volume of 7.5 mL of 1:10000 epinephrine. One hundred patients (75.5%) with documented H pylori infection (by rapid urease test and histologic findings) were randomly assigned to receive 40 mg omeprazole intravenously every day and ampicillin-sulbactam 750 mg three times daily intravenouslY for 3 days and 20 mg omeprazole twice daily and 500 mg amoxicillin three times daily for 11 days (Group A) or 20 mg omeprazole twice daily and 500 mg amoxicillin three times daily for 2 weeks (Group B). Subsequently, both group received 20 mg omeprazole daily orally for 4 weeks. Patients underwent a second endoscopy 3 days later and again at the end of 6 weeks. Results: Early rebleeding occurred less in Group A. (1/50 or 2% vs 5/50 or 10%, P > 0.05). All these 6 patients were excluded. Disappearance of major SRH was significantly higher in Group A (45/49 or 91.8%) than in Group B (32/45 or 71.1%; P 0.05) Ulcer healing rates were 93.8% (46/49) in Group A and 95.5% (43/45) in Group B. (P > 0.05) Conclusions: Intravenous form of dual therapy can be started immediately in HP-positive acute ulcer hemorrhage with major SRH then follow by oral antiHp therapy. Rapid disappearance of major SRH and lower early rebleeding rate could be achieved. It can be an alternative choice for H pylori treatment in acute peptic ulcer bleeding.