The influence of intravenous omeprazole on intragastric pH and outcomes inpatients with peptic ulcer bleeding after successful endoscopic therapy - A prospective randomized comparative trial

BACKGROUND/AIMS: The role of omeprazole in preventing rebleeding in patient s with peptic ulcer bleeding after successful endoscopic therapy has been c ontroversial. In this study, we used 3 different formulas of intravenous om eprazole in the above patients. We wished to compare the intragastric pH an d outcomes among them. METHODOLOGY: Between July 1996 and May 1997, after having obtained initial hemostasis with endoscopic therapy, a total of 20 patients with peptic ulce r bleeding (spurting/oozing/non-bleeding visible vessel: 6/4/10) received i ntravenous bolus of omeprazole 20mg every 3 hours; 20 patients (3/5/12) rec eived intravenous bolus of omeprazole 40mg every 6 hours; and, 20 patients (5/4/11) received intravenous bolus of omeprazole 80mg every 12 hours for 3 days. One intragastric pH meter (Gastrograph Mark III, Medical Instruments Corp. Switzerland) was used to record 24-hour intragastic pH. RESULTS: The intragastric pH in the patients receiving omeprazole 20mg ever y 3 hours was 6.1, 6.0-6.2 (mean: 95%C I); in patients receiving omeprazole 40mg every 6 hours it was 6.4, 6.2-6.5; and, in patients receiving omepraz ole 80mg every 12 hours it was 5.8, 5.7-5.9. The duration of intragastric p H >6.0 in omeprazole 20mg every 3 hours was 70.9%, 57.3%-84.4% (mean: 95% C I); in omeprazole 40mg every 6 hours it was 83.1%, 73.1%-93.1%) and, in ome prazole 80mg every 12 hours it was 66%, 51.5%-80.4%. Patients with peptic u lcers receiving omeprazole 40mg intravenous bolus every 6 hours had the hig hest intragastric pH as compared with the other 2 groups (p<0.0001). There were no significant differences concerning rebleeding rates, volume of bloo d transfusion, hospital stay, numbers of operation and mortality among the 3 groups. CONCLUSIONS: After initial hemostasis had been obtained, patients with pept ic ulcer bleeding receiving 40mg intravenous bolus every 6 hours had the hi ghest intragastric pH. However, they had similar outcomes with the other 2 groups.