Abstract

A STUDY ON ORAL OR INTRAVENOUS PROTON PUMP INHIBITOR IN PATIENTS WITH PEPTIC ULCER BLEEDING

Y. Srujana*, K. Anjali, K. Niharika, Sameena Begum, K. Kavitha and N. Prasanna Laxmi

ABSTRACT

Peptic ulcer disease (PUD) is a break in the lining of the stomach, first part of the small intestine or occasionally the lower esophagus.[1][7] An ulcer in the stomach is known as a gastric ulcer while that in the first part of the intestines is known as a duodenal ulcer.[1] We aimed to assess the clinical effectiveness of oral vs. intravenous (i.v.) regular-dose proton pump inhibitor (PPI) after endoscopic injection of epinephrine in patients with peptic ulcer bleeding. Patients were excluded from the study if they were pregnant, did not obtain initial haemostasis with endoscopic injection of epinephrine, did not give written informed consent, had bleeding tendency (platelet count <50 × 109 l−1, serum prothrombin<30% of normal, or were taking anticoagulants), had used PPI within 14 days of enrolment, had uraemia or bleeding gastric cancer. In summary, this single-centre, prospective, randomized, controlled trial of patients with high-risk bleeding ulcers has shown that oral and i.v. regular-dose PPI were equally effective as adjuvant pharmacotherapy to endoscopic haemostasis. Oral rabeprazole (20 mg twice daily) and i.v. infusion omeprazole (40 mg every 12 h) were not different in recurrent bleeding, surgery, blood transfusion or mortality. Our results suggest that oral PPI may be able to replace i.v. infusion PPI as the treatment of choice in peptic ulcer bleeding. However, more studies, particularly validating trials in Western countries, are necessary before oral PPI can be considered as the standard treatment.

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