Background
Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency
with significant morbidity and mortality. Intravenous (IV) route administration of
proton pump inhibitors is more commonly used for prevention of bleeding; however,
it is more expensive and invasive than the oral route. We, herein, compared
between oral and IV omeprazole in patients with high-risk UGIB regarding outcome.
Patients and methods
Patients with high risk for rebleeding peptic ulcers were included. All patients initially
received IV omeprazole, and then esophagogastroduodenoscopy with hemostatic
procedure was done. Thereafter, the patients were allocated to group A, who
received oral omeprazole, and group B, who received IV omeprazole. The patients
were followed up for 2 weeks for signs of rebleeding. Reendoscopy,
angioembolization, or surgery was provided when needed.
Results
The study included 189 patients (96 in group A and 93 in group B). Frequency of
rebleeding was higher among patients in group B (40%) compared with those in
group A (30%) (P: 0.1). Reendoscopy was more frequently required for patients in
group B (16.1%) than those in group A (3.1%) (P<0.001). Surgery was mandatory
for three (3.2%) patients in group B, whereas angioembolization was used nearly
equally in both groups (31.3% in group A vs. 29% in group B). Admission to ICU was
more frequently needed (P: 0.02) and the length of hospital stays was longer (P:
0.003) for patients of group B. Regarding UGIB-related deaths, three (3.1%)
patients from each group died.
Conclusion
Oral omeprazole is not inferior to IV omeprazole as adjuvant therapy to control
peptic ulcer bleeding and to reduce the frequency of rebleeding.