Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers.

Background: After endoscopic treatment of bleeding peptic ulcers, bleeding recurs in 15 to 20 percent of patients. Methods: We assessed whether the use of a high dose of a proton-pump inhibi tor would reduce the frequency of recurrent bleeding after endoscopic treat ment of bleeding peptic ulcers. Patients with actively bleeding ulcers or u lcers with nonbleeding visible vessels were treated with an epinephrine inj ection followed by thermocoagulation. After hemostasis had been achieved, t hey were randomly assigned in a double-blind fashion to receive omeprazole (given as a bolus intravenous injection of 80 mg followed by an infusion of 8 mg per hour for 72 hours) or placebo. After the infusion, all patients w ere given 20 mg of omeprazole orally per day for eight weeks. The primary e nd point was recurrent bleeding within 30 days after endoscopy. Results: We enrolled 240 patients, 120 in each group. Bleeding recurred wit hin 30 days in 8 patients (6.7 percent) in the omeprazole group, as compare d with 27 (22.5 percent) in the placebo group (hazard ratio, 3.9; 95 percen t confidence interval, 1.7 to 9.0). Most episodes of recurrent bleeding occ urred during the first three days, which made up the infusion period (5 in the omeprazole group and 24 in the placebo group, P<0.001). Three patients in the omeprazole group and nine in the placebo group underwent surgery (P= 0.14). Five patients (4.2 percent) in the omeprazole group and 12 (10 perce nt) in the placebo group died within 30 days after endoscopy (P=0.13). Conclusions: After endoscopic treatment of bleeding peptic ulcers, a high-d ose infusion of omeprazole substantially reduces the risk of recurrent blee ding. (N Engl J Med 2000;343:310-6.) (C) 2000, Massachusetts Medical Societ y.