Bleeding Peptic Ulcers Disease Clinical Trial
Official title:
Intravenous Infusion of High Dose Omeprazole Versus Regular Dose Omeprazole on Recurrent Bleeding After Endoscopic Treatment of Bleeding Peptic Ulcers
Bleeding peptic ulcers are one of the major causes of morbidity and mortality for hospital emergency admissions.The initial treatment is endoscopic therapy followed by intravenous omeprazole. However the optimal dosage of omeprazole is not known. We conducted this study to find out the optimal dosage in such clinical scenario.
Introduction
Peptic ulcer bleeding (PUB) is a common and life threatening condition. Intravenous infusion
of high dose omeprazole (80mg as bolus followed by 8 mg/hr for 72 hours ie 652 mg/72 hrs)
after endoscopic therapy resulted in greater reductions of re-bleeding than did placebo.
Thus the above regime became our departmental protocol. However, there is some evidence that
both high dose and a regular dose of omeprazole (40mg once a day followed by a saline
infusion ie 120mg/72 hrs) would be equally effective. We calculated that high dose regimen
is about S$ 500 more expensive. The aim of our study is to determine the equivalence of both
regimes in preventing re-bleeding rate (primary end-point), surgery and mortality in PUB
patients.
Study design This is a single institution prospective randomized double-blind study. All
patient with PUB (Forrest classification I, IIa and IIb: spurting or oozing bleeding,
visible vessels and clot) had endoscopic treatments (adrenaline injection and/or heater
probe). After successful endoscopic hemostasis, patients are randomized to receive a high or
regular dose of omeprazole infusion. After 72 hours, both groups of patients are given oral
omeprazole 40mg daily for 4 weeks. All patients are evaluated at the clinic at the end of 4
weeks. The primary end-point is rebleeding. Other secondary endpoints measured are surgery,
duration of hospital stay and death.
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