Digestive Diseases and Sciences

, Volume 52, Issue 12, pp 3371–3376 | Cite as

Oral Proton Pump Inhibitors Are as Effective as Endoscopic Treatment for Bleeding Peptic Ulcer: A Prospective, Randomized, Controlled Trial

  • Jin II Kim
  • Dae Young Cheung
  • Se Hyun Cho
  • Soo-Heon Park
  • Joon-Yeol Han
  • Jae Kwang Kim
  • Sok Won Han
  • Kyu Yong Choi
  • In Sik Chung
Original Paper


In managing patients with bleeding peptic ulcers, it has been reported that pharmacologic treatment can be an alternative to endoscopic treatment. We compared the hemostasis rates of the endoscopic treatment, hemoclipping, and the phamacologic treatment, oral proton pump inhibitors (PPIs), in bleeding peptic ulcer. A randomized prospective study was performed on 129 bleeding peptic ulcer patients with hematemesis or melena. Sixty-two patients were treated by endoscopic hemoclipping and subsequently H2 receptor antagonists were injected intravenously (hemoclipping group), and 67 patients were treated with an oral PPI without endoscopic treatment (PPI group). The 24-hr gastric pH test was performed sequentially following the treatment. The initial hemostasis rate of the hemoclipping group was 93.5% (58/62) and the rebleeding rate was 6.9% (4/58), and the hemostasis rate of the PPI group was 92.5% (62/67) and the rebleeding rate was 7.5% (5/67), which were not different. The 24-hr gastric pH was 4.54 ± 2.56 in the hemoclipping group and 5.97 ± 1.30 in the PPI group (P < 0.037). In the bleeding peptic ulcer patients, the hemostasis rate with the oral administration of PPIs was not different from that with the endoscopic hemoclipping treatment.


Ulcer bleeding Proton pump inhibitors Hemoclip 


  1. 1.
    Khuroo MS, Yattoo GN, Javid G, et al. (1997) A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med 336:1054–1058PubMedCrossRefGoogle Scholar
  2. 2.
    Jensen DM (1990) Heat probe for hemostasis of bleeding peptic ulcers: techniques and results of randomized controlled trials. Gastrointest Endosc 36:S42–S49PubMedGoogle Scholar
  3. 3.
    Wara P (1985) Endoscopic prediction of major rebleeding—a prospective study of stigmata of hemorrhagie in bleeding ulcer. Gastroenterology 88:1209–1214PubMedGoogle Scholar
  4. 4.
    Griffiths WJ, Neumann DA, Welsh JD (1979) The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med 300:1411–1413PubMedCrossRefGoogle Scholar
  5. 5.
    Collins R, Langman M (1985) Treatment with histamine H2 antagonists in acute upper gastrointestinal hemorrhage. Implications of randomized trials. N Engl J Med 313:660–666PubMedCrossRefGoogle Scholar
  6. 6.
    Barer D, Ogilvie A, Henry D, et al. (1983) Cimetidine and tranexamic acid in the treatment of acute upper-gastrointestinal–tract bleeding. N Engl J Med 308:1571–1575PubMedCrossRefGoogle Scholar
  7. 7.
    Cook DJ, Guyatt GH, Salena BJ, Laine LA (1992) Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 102:139–148PubMedGoogle Scholar
  8. 8.
    Krejs GJ, Little KH, Westergaard H, Hamilton JK, Spady DK, Polter DE (1987) Laser photocoagulation for the treatment of acute peptic-ulcer bleeding. A randomized controlled clinical trial. N Engl J Med 316:1618–1621PubMedCrossRefGoogle Scholar
  9. 9.
    Walt RP, Cottrell J, Mann SG, Freemantle NP, Langman MJ (1992) Continuous intravenous famotidine for haemorrhage from peptic ulcer. Lancet 340:1058–1062PubMedCrossRefGoogle Scholar
  10. 10.
    Oxner RB, Simmonds NJ, Gertner DJ, Nightingale JM, Burnham WR (1992) Controlled trial of endoscopic injection treantment for bleeding from peptic ulcers with visible vessel. Lancet 339:966–968PubMedCrossRefGoogle Scholar
  11. 11.
    Palmer KR (2001) Intravenous omeprazole after endoscopic treatment of bleeding peptic ulcers. Gut 49:610–611PubMedCrossRefGoogle Scholar
  12. 12.
    Patchett SE, Enright H, Afdhal N, O'Connell W, O'Donoghue DP (1989) Clot lysis by gastric juice; an in vitro study. Gut 30:1704–1707PubMedCrossRefGoogle Scholar
  13. 13.
    Gralnek IM, Jensen DM, Gornbein J, et al. (1998) Clinical and economic outcome of individuals with severe peptic ulcer hemorrage and nonbleeding visible vessel; an analysis of two prospective clinical trials. Am J Gastroenterol 93:2047–2056PubMedCrossRefGoogle Scholar
  14. 14.
    Grosso C, Rossi A, Gambitta P, et al. (1995) Non-bleeding visible vessel treatment: perendoscopic injection therapy versus omeprazole infusion. Scand J Gastroenterol 30:872–875PubMedGoogle Scholar
  15. 15.
    Andriulli A, Annese V, Caruso N, et al. (2005) Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers: a series of meta-analyses. Am J Gastroenterol 100:207–219PubMedCrossRefGoogle Scholar
  16. 16.
    Kahi CJ, Jensen DM, Sung JJ, et al. (2005) Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis. Gastroenterology 129:855–862PubMedCrossRefGoogle Scholar
  17. 17.
    Gonzalez-Huix F, Figa M, Hombrados M, Gavalda L, Acero D (2000) Randomized controlled trial of endoscopic sclerotherapy compared with medical treatment for the prevesion of receurrent ulcer hemorrhage in patients with non-bleeding adherent clot. Endoscopy 32:E29 (abstr)Google Scholar
  18. 18.
    Jensen DM, Kovacs TO, Jutabha R, et al. (2002) Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 123:407–413PubMedCrossRefGoogle Scholar
  19. 19.
    Bleau BL, Gostout CJ, Sherman KE, et al. (2002) Recurrent bleeding from peptic ulcer associated with adherent clot; a randomized study comparing endoscopic treatment with medical therapy. Gastrointest Endosc 56:1–6PubMedCrossRefGoogle Scholar
  20. 20.
    Jung HK, Son HY, Jung SA, et al. (2002) Comparison of oral ometrazole and endoscopic ethanol injection therapy for prevention of recurrent bleeding from peptic ulcers with nonbleeding visible vessels or fresh adherent clots. Am J Gastroenterol 97:1736–1740PubMedCrossRefGoogle Scholar
  21. 21.
    Sung JJ, Chan FK, Lau JY, et al. (2003) The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots; a randomized comparison. Ann Intern Med 139:237–243PubMedGoogle Scholar
  22. 22.
    Lau JY, Sung JJ, Lee KK, et al. (2000) Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med 343:310–316PubMedCrossRefGoogle Scholar
  23. 23.
    Green FWV Jr, Kaplan MM, Curtis LE, Levine PH (1978) Effect of acid and pepsin on blood coagulation and platelet aggregation. A possible contributor prolonged gastroduodenal mucosal hemorrage. Gastroenterology 74:38–43PubMedGoogle Scholar
  24. 24.
    Leveen HH, Falk G, Diaz C, et al. (1972) Control of gastrointestinal bleeding. Am J Surg 123:154–159PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Jin II Kim
    • 1
  • Dae Young Cheung
    • 1
  • Se Hyun Cho
    • 1
  • Soo-Heon Park
    • 1
    • 2
  • Joon-Yeol Han
    • 1
  • Jae Kwang Kim
    • 1
  • Sok Won Han
    • 1
  • Kyu Yong Choi
    • 1
  • In Sik Chung
    • 1
  1. 1.Division of GastroenterologyDepartment of Internal Medicine, The Catholic University of KoreaSeoulKorea
  2. 2.SeoulKorea

Personalised recommendations