Use of omeprazole in the management of giant duodenal ulcer: Results of a prospective study

Background, Giant duodenal ulcer (GDU) is generally thought to require surg ical intervention. Proton lump inhibitors have beneficial effects in peptic ulcer disease, but their role in GDU disease is unknown. We examined the u se of omeprazole in GDU management. Methods. Twenty-eight patients were diagnosed with GDU. One patient require d immediate operative intervention. The remaining 27 were placed on, omepra zole (40 mg daily). When ulcer healing was documented by endoscopy, the pat ients were placed on oral histamine-2 receptor antagonist therapy. Results, Of the 28 study patients, 20 (71.4 %) did not require operative in tervention, and 8 (28.6%) required operation for ulcer complications. Of th e 15 patients with adherent clot or a visible vessel at initial endoscopy, 7 (46.7%) required operative intervention as compared with 1 (7.7%) of the 13 patients without a visible vessel or adherent clot. This difference was statistically significant (P <.05). Twenty-three patients underwent antral biopsy and/or enzyme-linked immunosorbent assay for Helicobacter pylori, an d 9 (39.1 %) had a positive result. Conclusions. Omeprazole is effective in the treatment of GDU disease. An ad herent clot or a visible vessel at endoscopy indicates a higher likelihood of complications requiring operation. The relatively low H pylori infection rate, as compared with other peptic ulcer disease, may indicate a differen t pathophysiology in GDU.