The Efficacy of High- and Low-Dose Intravenous Omeprazole in Preventing Rebleeding for Patients with Bleeding Peptic Ulcers and Comorbid Illnesses

Abstract

This study sought to determine if high-dose omeprazole infusion could improve the control of rebleeding in patients with comorbid illnesses and bleeding peptic ulcers. After achieving hemostasis by endoscopy, 105 patients were randomized into high-dose (n = 52) and low-dose (n = 53) groups, receiving 200 and 80 mg/day omeprazole, respectively, as a continuous infusion for 3 days. Thereafter, oral omeprazole, 20 mg/day, was given. The cumulative rebleeding rates comparatively rose in both groups (high-dose vs. low-dose group), beginning on day 3 (15.4% vs. 11.3%), day 7 (19.6% vs. 20%), and day 14 (32.7% vs. 28.9%), until day 28 (35.4% vs. 33.3%), and were not significantly different between the two groups (P > 0.50). Multiple logistic regression confirmed that a serum albumin level <3 g/dL was an independent factor associated with rebleeding (P = 0.002). For patients with comorbidities, 3-day omeprazole infusion, despite increasing the daily dose from 80 to 200 mg, was not adequate to control peptic ulcer rebleeding.

High-dose vs. Low-dose Proton Pump Inhibitors post-endoscopic hemostasis in patients with bleeding peptic ulcer. A meta-analysis and meta-regression analysis

“…Ten of 859 screened RCTs were finally included (2,7,8,(11)(12)(13)(14)(15)(16)(17) with a total of 1.651 participants.…”

“…All RCTs regarding low-versus high-dose PPI administration post-endoscopic hemostasis were identified (2,7,8,(11)(12)(13)(14)(15)(16)(17). In keeping with identification of suitable studies, the electronic databases Medline, Embase, PubMed, and the Cochrane Library were utilized to identify articles from 2000 to 2016 in the English language literature which included the following terms and/or amalgamations in their keyword lists, abstracts, or titles: RCT, double-blind, dexlansoprazole, omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole, high-dose PPI, low-dose PPI, PPI, and bleeding.…”

“…The difference between failed hemostasis and rebleeding was not distinctly defined. Four studies (2,14,15,17) excluded patients from registration if they did not have spontaneous hemostasis or bleeding was not fostered via endoscopic methods. Consequently, hemorrhage after the primary endoscopic intervention could be considered as rebleeding.…”

Higher Risk of Developing Peptic Ulcer Bleeding in Adult Patients Diagnosed with Hypoalbuminemia

“…However, our methods were used to analyze patients diagnosed with hypoalbuminemia who were nationally-based, conduct a long-term follow-up, evaluate ulcerogenic medications, and conduct an 11 year-long longitudinal study, and PUB for hospitalization. Cheng et al, [5] conducted a study and disclosed that hypoalbuminemia with comorbid illness has a higher risk of developing a 7-day and a 28-day recurrent PUB. The intra-stomach acid environment is crucial for the acute stage of ulcer healing.…”

“…Malnutrition and lower serum albumin levels affect peptic ulcer healing and cause peptic ulcer bleeding (PUB) and other complications [5]. Rady et al, [6] proposed that hypoalbuminemia patients receiving cardiac surgery were at a higher risk of developing PUB and facing lifethreatening episodes.…”