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Combination Treatment for Peptic Ulcers at High Risk for Recurrent Bleeding FREE

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The summary below is from the full report titled “The Effect of Endoscopic Therapy in Patients Receiving Omeprazole for Bleeding Ulcers with Nonbleeding Visible Vessels or Adherent Clots. A Randomized Comparison.” It is in the 19 August 2003 issue of Annals of Internal Medicine (volume 139, pages 237-243). The authors are J.J.Y. Sung, F.K.L. Chan, J.Y.W. Lau, M.-Y. Yung, W.-K. Leung, J.C.Y. Wu, E.K.W. Ng, and S.C.S. Chung.


Ann Intern Med. 2003;139(4):I-12. doi:10.7326/0003-4819-139-4-200308190-00001
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What is the problem and what is known about it so far?

Peptic ulcers are eroded areas in the lining of the stomach or duodenum (the first part of the intestine). They occur when acidic digestive juices eat away the lining. Deep ulcers can erode into blood vessels and cause bleeding, the most common and serious complication of peptic ulcers.

Doctors sometimes pass a tube (endoscope) through the mouth to the stomach to examine ulcers. During endoscopy, they may use a heat probe or inject drugs to seal bleeding blood vessels. Doctors also give patients with ulcers drugs that suppress acid production (proton-pump inhibitors). Both the endoscopic treatment and the proton-pump inhibitors help stop active bleeding and prevent recurrent bleeding. Some patients have already stopped bleeding when they undergo endoscopy, but if there are visible blood vessels or fixed clots at the ulcer, the risk for recurrent bleeding is very high. We do not know whether these patients need treatment during endoscopy or just proton-pump inhibitors to help prevent recurrent bleeding.

Why did the researchers do this particular study?

To see if combined endoscopic and proton-pump inhibitor (omeprazole) treatment is better than omeprazole alone in patients who have recently bled from a peptic ulcer but who no longer have actively bleeding vessels.

Who was studied?

156 patients admitted to a hospital for bleeding from a peptic ulcer.

How was the study done?

All patients had endoscopy within 24 hours of admission. At endoscopy, doctors identified patients who were no longer actively bleeding but who had either visible blood vessels or fixed clots at the ulcer. Researchers randomly assigned these patients to receive endoscopic treatment plus omeprazole or omeprazole alone. Endoscopic treatment of the blood vessel included injection of epinephrine and coagulation with a heat probe. Omeprazole was given through the vein for 3 days and was then given by mouth. Patients were followed for 30 days to detect any recurrence of bleeding.

What did the researchers find?

Bleeding recurred less often in patients given combined endoscopic and omeprazole treatment than in patients given omeprazole alone. Before hospital discharge, no patients receiving combined therapy and 9% of patients given omeprazole alone had recurrent bleeding. Within 30 days, approximately 1% and 12% of patients given combined therapy and omeprazole only, respectively, had recurrent bleeding.

What were the limitations of the study?

The study was small and limited to one hospital.

What are the implications of the study?

Endoscopic treatment combined with omeprazole better prevents recurrent bleeding than omeprazole alone in patients who have recently bled from a peptic ulcer but do not have actively bleeding vessels at the time of endoscopy.

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