Oral or Intravenous Proton Pump Inhibitor in Patients with Peptic Ulcer Bleeding after Successful Endoscopic Epinephrine Injection – a Prospective Randomized Comparative Trial

Abstract

Purpose: We aim to assess the outcomes of oral versus low-dose intravenous proton pump inhibitor after endoscopic injection of epinephrine in patients with peptic ulcer bleeding. Methods: This is a prospective randomized controlled trial conducted in a medical center in Taiwan. From January 2007 to December 2007, peptic ulcer patients with active bleeding, non-bleeding visible vessels or adherent clots were enrolled after successful endoscopic hemostasis achieved by injection with 10 ml diluted epinephrine (1:10,000). They were randomized to receive either oral rabeprazole (RAB group, 20 mg twice daily for 3 days, and then 20 mg orally once daily for 2 months) or omeprazole (OME group, 40 mg intravenous infusion every 12 hours for 3 days, and then 40 mg esomeprazole orally once daily for two months). The primary end point was the 14-day rebleeding rate. The hospital stay, volume of blood transfused, number of surgeries performed, and the mortality rates at day 14 were compared as well. Results: A total of 156 patients were enrolled, with 78 patients allocated in the OME group and 78 in the RAB group. Rebleeding occurred in 12 patients (15.4%) in the OME group and 13 patients (16.7%) in the RAB group within 14 days (P > 0.1). The two groups were not different statistically in the hospital stay (mean: 8.52 days in OME group versus 8.86 days in RAB group, P > 0.1), volume of blood transfusion (mean: 1231 ml in OME group versus 1156 ml in RAB group, P > 0.1), numbers of patients requiring urgent operation (one patient of each group), and mortality rate (1 patient in OME group and 2 patients in RAB group, P > 0.1). Conclusion: Oral rabeprazole and low-dose intravenous omeprazole are equally effective in preventing rebleeding in patients with high-risk bleeding peptic ulcers after successful endoscopic injection with epinephrine.Table: Clinical variables of patients at entry to the studyTable: Outcomes of patients received oral versus low-dose intravenous proton pump inhibitor