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The Effect of Endoscopic Therapy in Patients Receiving Omeprazole for Bleeding Ulcers with Nonbleeding Visible Vessels or Adherent Clots: A Randomized Comparison

Joseph J.Y. Sung, MD, PhD, FRCP, FRACP; Francis K.L. Chan, MD, FRCP; James Y.W. Lau, MD, FRCS; Man-Yee Yung, BSc; Wai-Keung Leung, MD, MRCP; Justin C.Y. Wu, MD, MRCP; Enders K.W. Ng, MD, FRCS; and S.C Sydney Chung, MD, FRCS, FRCP
[+] Article, Author, and Disclosure Information

From Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong.

Acknowledgments: The authors thank Ms. Jessica Ching and Mr. Albert Cheung for statistical advice and the nursing staff of the Endoscopy Center for their generous support.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Joseph J.Y. Sung, MD, Endoscopy Center, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong; e-mail, joesung@cuhk.edu.hk.

Current Author Addresses: Drs. Sung, Chan, Lau, Leung, Wu, Ng, and Chung and Ms. Yung: Endoscopy Center, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.

Author Contributions: Conception and design: J.J.Y. Sung, F.K.L. Chan, J.Y.W. Lau, S.C.S. Chung.

Analysis and interpretation of the data: F.K.L. Chan, M.-Y. Yung.

Drafting of the article: J.J.Y. Sung.

Critical revision of the article for important intellectual content: F.K.L. Chan, J.Y.W. Lau.

Final approval of the article: J.J.Y. Sung, S.C.S. Chung.

Provision of study materials or patients: J.J.Y. Sung, W.-K. Leung, J.C.Y. Wu, E.K.W. Ng.

Administrative, technical, or logistic support: M.-Y. Yung.

Ann Intern Med. 2003;139(4):237-243. doi:10.7326/0003-4819-139-4-200308190-00005
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In the 18-month period from January 2001 to July 2002, 1810 patients were admitted to the Prince of Wales Hospital with upper gastrointestinal bleeding. Among them, 1004 were found to have peptic ulcers. One hundred seventy-eight patients had active ulcer bleeding (spurting or oozing), and 196 patients had nonactive bleeding ulcer with visible vessel or clot. Of these 196 patients, 162 were recruited for the study and 34 were excluded. Among the latter group, 18 did not provide consent, 4 had had previous gastrectomy, 3 had terminal malignant disease, 5 had had previous endoscopic therapy within 30 days, 1 had a perforated ulcer, 1 with a clot had bleeding provoked by endoscopic manipulation before randomization, 1 had gastrointestinal bleeding of unknown origin, and 1 had disseminated intravascular coagulation. Six patients in whom malignant ulcers were subsequently confirmed were excluded after randomization (Figure 1).

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Figure 2.
Kaplan–Meier estimates of the likelihood of recurrent ulcer bleeding within 30 days.

IV = intravenous.

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Summary for Patients

Combination Treatment for Peptic Ulcers at High Risk for Recurrent Bleeding

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.


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