RESUMEN
In this randomized controlled trial done at the National Cheng Kung University, Tainan, Taiwan, Cheng et al. aimed to establish the role of an increased and more aggressive dosage of esomeprazole in reducing peptic ulcer bleeding in high-risk patients. They aimed to evaluate whether a twice-daily oral dose of esomeprazole would be more effective than the present approach of a single-daily dose of 40 mg oral esomeprazole after the initial infusion in patients with high Rockall scores. They enrolled 293 patients with bleeding peptic ulcers who were managed with endoscopic means and esomeprazole infusion for 3 days following which, patients with a Rockall score >6 were randomized to receive either oral esomeprazole 40 mg twice daily (double-dose group; n=93) or once daily (standard-dose group; n=94). This therapy was continued for 11 days following which esomeprazole was continued in a once-daily dose for another 2 weeks till the 28-day study period. Among patients with high Rockall scores, the cumulative proportion of rebleeding-free patients was higher in the double-dose group as compared with the standard-dose group (p=0.02). The day 4 to 28 rebleeding in patients with a high Rockall score was significantly lower in the double-dose group compared with the standard-dose group (10.8% v. 28.7%, p=0.002). The proportion of patients free from rebleeding during days 4 to 28 among patients with a high Rockall score in the double-dose group remained lower than that of the group with a Rockall score <6 (p=0.03).