Peptic ulcer bleeding in the elderly and analysis of its correlation with Helicobacter pylori infection / 公共卫生与预防医学

Objective To analyze the risk factors of bleeding in elderly patients with peptic ulcer disease (PUD) and its correlation with Helicobacter pylori (Hp) infection, and to provide a theoretical basis for clinical diagnosis and treatment of elderly patients with PUD bleeding. Methods A total of 418 elderly PUD patients admitted to our hospital from June 2019 to June 2020 were selected. The 13C-urea breath test was used to determine HP infection. PUD patients were divided into observation group (n=87, bleeding) and control group (n=331, no bleeding). Age, sex, ulcer number, ulcer location, ulcer stage, ulcer diameter and other clinical data were collected. Univariate analysis and logistic regression were used to analyze the risk factors of bleeding in elderly PUD patients. The Forrest classification was used to evaluate the severity of PUD bleeding patients. Pearson correlation analysis was performed between Forrest classification and Hp infection in elderly PUD bleeding patients. Results There were statistically significant differences between the two groups in the course of disease, PUD history, NSAIDs application/ulcer number, ulcer diameter, ulcer location, ulcer stage, Hp infection and NSAIDs application (P<0.05). Multivariate logistic regression analysis showed that the use of NSAIDs, active ulcer, Hp infection and ulcer diameter ≥2 cm were risk factors for bleeding in elderly patients with PUD (P<0.05). The Hp positive rate in Forrest I patients was significantly higher than that in Forrest II and Forrest III patients (P<0.05). The positive rate of Hp in Forrest II patients was significantly higher than that in Forrest III patients. Pearson correlation analysis showed that Hp infection was positively correlated with the severity of peptic ulcer bleeding in the elderly (r=0.512, P<0.05). Conclusion The risk of bleeding from PUD is higher in the elderly, especially in patients with active ulcer, Hp infection and ulcer diameter ≥ 2 cm. In the treatment process of PUD patients, the eradication therapy of Hp should be emphasized, which can reduce the risk of bleeding.

Clinical characteristics of non-steroidal anti-inflammatory drugs induced peptic ulcer bleeding / 实用医学杂志

Objective To study the clinical characteristics of non-steroidal anti-inflammatory drugs (NSAIDs)induced peptic ulcer bleeding(PUB). Methods The case-control study was used to analyze the clinical data of 142 patients with NSAIDs-induced PUB and 210 patients with non-NSAIDs-induced PUB. Results There were significant differences between the two groups regarding sex and age of patient,history of rheumatic diseases or cardio-cerebral-vascular disease,types and numbers of ulcer,abdominal pain,hemoglobin concentration,and hospital stay(P<0.05),but there was no obvious difference in terms of the size of ulcer,BUN and HP infection rate. Conclusion Proper measures should be employed to decrease the complications of NSAIDs-induced PUB.

Pharmacological Treatment for Peptic Ulcer Bleeding

Peptic ulcer bleeding (PUB) is the most common cause of non-variceal upper gastrointestinal bleeding, and its frequency has been declining over the past decades. However, mortality from PUB persists, and it is still a serious challenge in clinical practice. Although endoscopic intervention is the basic treatment modality for PUB, pharmacological therapy is an important adjunct. The emergence of proton pump inhibitors (PPIs) enables maintenance of intragastric pH >6, which greatly helps in the treatment of PUB. Continuous intravenous infusion of high-dose PPI reduces the re-bleeding rate, thereby helping avoid additional surgery in patients with high-risk stigmata. Moreover, administration of PPIs prior to endoscopy may reduce the need for additional endoscopic intervention. Recently introduced gastric acid suppressants, such as potassium-competitive acid blockers, have shown promising results in further treatment of PUB.

Comparison of over-the-scope clip and traditional through-the-scope clip in the treatment of peptic ulcer bleeding / 中国内镜杂志

Objective?To compare the difference between endoscopic hemostasis with over-the-scope clip and conventional endoscopic hemostasis with through-the-scope clip for treatment of peptic ulcer bleeding.?Methods?Using the method of retrospective study, 22 cases of peptic ulcer bleeding patients treated by endoscopic hemostasis with over-the-scope clip and 24 cases recently completed by endoscopic hemostasis with through-the-scope clip before the application of endoscopic hemostasis with over-the-scope clip as the research object, then evaluate the efficacy and safety of endoscopic hemostasis with over-the-scope clip by comparing immediate hemostasis success (rate), the total number of clips used for operation, first successful hemostasis (rate), postoperative recurrence (rate), hemostasis success (rate), rebleeding (rate), two endoscopic treatment (rate), permanent hemostasis (rate), complication (rate), postoperative hospital stay (d), mortality (rate).?Results?Immediate hemostasis success (rate) of peptic ulcer bleeding patients treated by endoscopic hemostasis with over-the-scope clip was 20/22 (90.9%) and the total number of clips used for operation was 22, the first successful hemostasis (rate) was 20/22 (90.9%), postoperative recurrence (rate) was 1/20 (5.0%), successful hemostasis (rate) was19/22 (86.4%), rebleeding (rate) was 1/20 (5.0%), two endoscopic treatment (rate) was 3/22 (13.6%), permanent hemostasis (rate) was 18/22 (81.8%), complications (rate) was 0/22 (0.0%), postoperative hospital stay time (d) was (8.95 ± 0.96) d, death (rate) was 0/22 (0.0%). Immediate hemostasis success (rate) of peptic ulcer bleeding patients treated by hemostasis therapy with through-the-scope clip was 13/24 (54.2%) and the total number of clips used for operation was 56, the first successful hemostasis (rate) was 13/24 (54.2%), postoperative recurrence (rate) was 0/13 (0.0%), successful hemostasis (rate) was 13/24 (54.2%), rebleeding (rate) was 0/13 (0.0%), two endoscopic treatment (rate) was 11/24 (45.8%), permanent hemostasis (rate) was 13/24 (54.2%), complications (rate) was 0/24 (0.0%), hospitalization time after operation (d) was (8.54 ± 0.53) d, death (rate) was 1/24 (4.2%). Immediate hemostasis success (rate), first successful hemostasis (rate), hemostasis success (rate), and permanent hemostasis (rate) were higher in the OTSC group than in the TTSC group. However, two endoscopic treatment (rate) was lower in the OTSC group than in the TTSC group (P < 0.05).?Conclusion?Endoscopic hemostasis with over-the-scope clip is safe and effective on the treatment of peptic ulcer bleeding,it can be used as the first choice for the treatment of complicated and refractory peptic ulcer bleeding due to rupture of blood vessel with the larger diameter or other causes.

Effect of pantoprazole and norepinephrine injection on serum levels of inflammatory factors and hemostasis in peptic ulcer bleeding / 中国生化药物杂志

Objective To evaluate the effect of pantoprazole and norepinephrine injection on serum levels of inflammatory factors and hemostasis in the treatment of patients with peptic ulcer bleeding .Methods 102 cases of patients with peptic ulcer bleeding from September 2014 to September 2016 in our hospital were selected and randomly divided into observation group ( n =51 ) and control group ( n =51 ) .Observation group were received pantoprazole and norepinephrine injection combination therapy, the control group received only pantoprazole therapy.The treatment lasted 3 days.The efficacy, bleeding time, hospitalization and blood transfusion, serum IL-6 and IL-10 levels, the incidence of rebleeding and incidence of adverse reactions were compared between two groups.Results The overall response rate ( 98.02%) was significantly higher ( 82.35%) ( P<0.05 );observation group bleeding time was significantly faster than the control group ( P<0.05 ) , length of hospital stay was significantly shorter than the control group (P<0.05), blood transfusion was significantly less than the control group (P<0.05); levels of serum IL-6, IL-10 after treatment were lower than those before treatment (P<0.05); the serum levels of IL-6, IL-10 after treatment were significantly lower than those in control group (P<0.05); rebleeding rate in observation group was significantly lower than that in control group (P<0.05);there was no significant difference in adverse reactions between two groups.Conclusion Pantoprazole and norepinephrine injection in the treatment of digestive bleeding ulcer bleeding has the obvious effect, can reduce serum levels of inflammatory factors, while also reduce the incidence of rebleeding, safe and reliable.

Comparison of the effects of oral and intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer / 中国基层医药

Objective To compare the clinical effects of oral proton pump inhibitor and intravenous proton pump inhibitor in preventing re-bleeding for patients with peptic ulcer.Methods From January 2014 to December 2015,149 patients with peptic ulcer bleeding who came to our hospital for treatment and were successfully stanched by endoscopic therapy were chosen as study subjects.They were randomly divided into oral group and intravenous group according to random number table.The clinical effects,including re-bleeding rate,mortality and volume of blood transfusion were compared between the two groups.Results The re-bleeding rates within 20 days of the oral group and intravenous group were 5.6％ and 5.1％,respectively,and there was no statistically significant difference between the two groups (x2 =0.02,P ＞ 0.05).The hospital stay of the oral group and intravenous group were (4.0 ± 0.4) d and (2.1 ± 0.6) d,respectively,and there was statistically significant difference between the two groups (t =22.90,P ＜0.05).The volume of blood transfusion of the oral group and intravenous group were (1 001 ±284.2)mL and (601.0 ± 197.9) mL,respectively,and there was no significant difference between the two groups (t =0.90,P ＞ 0.05).Both two groups had no death within 30d and during surgery.Conclusion For the patients who were successfully cured by endoscopic therapy,the clinical effect of oral proton pump inhibitor is similar to the effect of intravenous proton pump inhibitor,and oral proton pump inhibitor is more easy operating and lower economic burden than intravenous proton pump inhibitor.

The correlation between early enteral nutrition and ventilator associated pneumonia in patients with severe cerebrovascular disease / 肠外与肠内营养

Objective:To investigate the effect of early enteral nutrition on ventilator-associated pneumonia in patients with severe cerebrovascular disease,and to evaluate nutritional status,intestinal nutrition tolerance,pH value of gastric juice and incidence of gastrointestinal bleeding.Methods:This study was a prospective study.The subjects were 72 patients with severe cerebrovascular disease in the intensive care unit of Neurology Department of our hospital from March 2014 to May 2017.All patients were treated with nasal feeding and mechanical ventilation.Among them,36 patients received enteral nutrition support treatment within 24 hours (early group),and 36 patients received enteral nutrition support treatment after 24 hours (control group).The two groups were compared with the incidence of ventilator-associated pneumonia,weaning success rate,complications of enteral nutrition rate,and gastrointestinal bleeding within 7 days,serum albumin and serum prealbumin level after 7 days,survival rate after 28 days.We also analyzed the changes in pH of the gastric juice at admission,1 day,3 days,7 days,and 14 days after treatments.Results:In the early group,the incidence of ventilator-associated pneumonia,gastrointestinal bleeding,complications of enteral nutrition,were lower than the control group.The serum level of albumin and prealbumin,the rate of successful weaning and 28 day survival rate were higher than the control group.After the early enteral nutrition,the pH value of gastric juice increased significantly.Conclusion:Early application of enteral nutrition support therapy can improve the nutritional status of patients,reduce the incidence of ventilatorassociated pneumonia,improve the success rate of weaning,reduce the fatality rate and improve the prognosis of patients.Early enteral nutrition support treatment can also increase pH value of gastric juice and reduce the incidence of gastrointestinal complication and gastrointestinal bleeding.

Analysis of the effect of Lyophilizing Thrombin Powder combined with omeprazole in the treatment of peptic ulcer bleeding / 中国生化药物杂志

Objective To explore the Lyophilizing Thrombin Powder combined with omeprazole in the treatment of peptic ulcer hemorrhage on clinical effect and influence on the change of the original level of the fiber protein.Methods118 cases of peptic ulcer bleeding from Yongkang Hospital were enrolled in this study, according to the order of hospitalization will be divided into observation group and control group.The control group were only given omeprazole and other conventional treatment;patients in the observation group was combined with Lyophilizing Thrombin Powder for treatment.The clinical treatment effect were compared between the two groups before and after treatment, compared two groups of patients with changes in fibrinogen levels.ResultsAfter treatment, the total efficiency rate of observation group was 91.07%, the total effective rate of control group was 75.81%, there was significant difference between two groups (P<0.05).Before treatment, two groups of patients with fibrinogen level was not statistically significant.With the treatment, the two groups of patients with fibrin the original level decreased, but the patients in the observation group decreased more significantly than the control group, the difference was statistically significant (P<0.05).ConclusionLyophilizing Thrombin Powder combined with omeprazole in the treatment of peptic ulcer bleeding effect significantly, can effectively reduce blood fibrinogen level, hemostasis, and its clinical use is safe and reliable, and is worth to popularize in clinic.

Efficacy and safety of domestic esomeprazole in the treatment of peptic ulcer bleeding / 中国生化药物杂志

Objective To analyze the safety and efficacy of domestic esomeprazole injection in treating peptic ulcer bleeding. Methods A total of 98 patients with peptic ulcer bleeding were enrolled in Zhejiang Xiaoshan hospital from January 2016 to December 2016 were divided into the observation group and the control group by random number table. Both groups were given the same routine treatment, the observation group was given domestic esomeprazole injection on the basis treatment, the control group was given imported eschenopramine injection, clinical efficacy and safety of two groups were compared. Results There was no significant difference in the effective rate of treatment, the total efficacy and adverse reactions between two groups, but the cost in the observation group was significantly lower than that of the control group (P<0.05). Conclusion For the treatment of peptic ulcer bleeding, both of domestic and imported eschenopramine injection treatment could be received more satisfactory clinical efficacy, but the cost of domestic esomeprazole injection is lower than that of imported esomeprazole..

Efficacy and safety of domestic esomeprazole in the treatment of peptic ulcer bleeding / 中国生化药物杂志

Objective To analyze the safety and efficacy of domestic esomeprazole injection in treating peptic ulcer bleeding. Methods A total of 98 patients with peptic ulcer bleeding were enrolled in Zhejiang Xiaoshan hospital from January 2016 to December 2016 were divided into the observation group and the control group by random number table. Both groups were given the same routine treatment, the observation group was given domestic esomeprazole injection on the basis treatment, the control group was given imported eschenopramine injection, clinical efficacy and safety of two groups were compared. Results There was no significant difference in the effective rate of treatment, the total efficacy and adverse reactions between two groups, but the cost in the observation group was significantly lower than that of the control group (P<0.05). Conclusion For the treatment of peptic ulcer bleeding, both of domestic and imported eschenopramine injection treatment could be received more satisfactory clinical efficacy, but the cost of domestic esomeprazole injection is lower than that of imported esomeprazole..

Corelationship between proton pump inhibitors and hospital-acquired pneumonia in abdominal surgical patients / 实用医学杂志

Objective To investigate the corelationship between proton pump inhibitors (PPI) and the incidence of hospital-acquired pneumonia (HAP) in abdominal surgical patients. Methods A total of 283 cases admitted from 2010 to 2014 were divided into PPI group (n = 326) and HRA group (n = 92). In PPI group, patients were divided into omeprazole subgroup (subgroup A, n = 146), lansoprazole subgroup (subgroup B, n = 102) and pantoprazole subgroup (subgroup C, n = 78) by the types of PPI. In HRA group, patients were divided into famotidine subgroup (subgroup D, n = 58) and ranitidine subgroup (subgroup E, n=34) by the types of histamine-2 receptor antagonist (H2RA). The incidence of stress ulcer bleeding (SUB) and HAP were calculated, while mechanical ventilation period (MV), ICU stay and 28-day-mortality were compared. Results There were lower incidences of SUB and HAP, shorter MV and ICU stay and lower 28-day-mortality in PPI group than those in HRA group (P < 0.05). In three subgroups of PPI group, there were no significant difference on incidence rate of SUB and HAP, as well as MV, ICU stay and 28-day-mortality. Conclusion The incidence rates of SUB and HAP are lower by using PPI than H2RA in abdominal surgical patients, as well as MV, ICU stay and 28-day-mortality. Different types of PPI have no effect on the incidence rate of HAP in abdominal surgical patients.

Endoscopic Management of Peptic Ulcer Bleeding

Acute upper gastrointestinal bleeding is a common medical emergency around the world and the major cause is peptic ulcer bleeding. Endoscopic treatment is fundamental for the management of peptic ulcer bleeding. Despite recent advances in endoscopic treatment, mortality from peptic ulcer bleeding has still remained high. This is because the disease often occurs in elderly patients with frequent comorbidities and are taking ulcerogenic medications. Therefore, the management of peptic ulcer bleeding is still a challenge for clinicians. This article reviews the various endoscopic methods available for management of peptic ulcer bleeding and the techniques in using these methods.

A Case of Early Gastric Cancer Resected Completely by Diagnostic Endoscopic Mucosal Resection Presented as Large Gastric Ulcer Bleeding

During the life cycle of early gastric cancer, some malignant ulcers may undergo partial or complete mucosal repair. Endoscopic visualization alone cannot reliably discriminate benign from malignant gastric ulcers. A 45-year-old man visited our hospital complaining of hematemesis. Endoscopy revealed a 2x2 cm sized, deep ulcer with adherent clots at the posterior wall of the gastric body. Proton pump inhibitor was prescribed for 2 months. Diagnostic endoscopic mucosal resection was performed. Histology revealed an early gastric cancer involving the lamina propria which was resected completely.

Clinical effect of Zhikang capsules on patients with gastric duodenal ulcer blooding / 中国综合临床

Objective To investigate the effect of Zhikang capsules on treatment of gastric duodenal ulcer bleeding.Methods Eighty patients with gastric duodenal ulcer bleeding were randomly divided to therapy group(patients received Pantoprazole(20 mg) + Zhikang capsules(1.2 g),2 time/d,n =46) and control group (patients received Pantoprazole,20 mg,2 time/d,n =34).All treatment period was a week.The clinical efficacy were evaluated.Results The rate of total effective of therapy group was 95.7％ (44/46),and control group was 79.4％ (27/34).The difference was statistically significant (x2 =5.164,P ＜ 0.05).Conclusion Zhikang capsules is proved to be an efficacy drug to treatment of gastric duodenal ulcer bleeding,and with less adverse reaction.

Research on effect of esomeprazole in treating elderly patients with NSAIDs correlated peptic ulcer bleeding / 中国医学装备

Objective: To study the effect of esomeprazole in treating elderly patients with NSAIDs correlated peptic ulcer bleeding. Methods: Patients with NSAIDs correlated peptic ulcer bleeding in our hospital from January, 2010-December, 2012 were enrolled and randomly divided into observation group given esomeprazole and control group given omeprazole. Then the baseline data were surveyed and effect of ulcer bleeding, condition of abdominal pain alleviation and ulcer ulcer, adverse reaction cases were observed. Results: (1)there were no significant difference between the baseline data of two group;(P>0.05);(2)in observation group, excellence rate was 42/70(60%), effective rate was 24/70(34.3%), the overall treatment effect was better than that of control group, the difference had statistical significant(P<0.05);(3)there were no significant difference between two group of abdominal pain and ulcer healing;(4) during treatment, there were no serious adverse reactions in the two groups. Conclusion:Compared with omeprazole, esomeprazole has equal effect on abdominal pain relief and ulcer healing, and it is much more effective in treating elderly patients with NSAIDs correlated peptic ulcer bleeding.

Effect Comparison of Omeprazole and Pantoprazole in the Treatment of Patients with Peptic Ulcer Bleeding / 中国药师

Objective:To compare the efficacy and adverse reactions of omeprazole and pantoprazole in the treatment of patients with peptic ulcer bleeding. Methods: Totally 362 cases of peptic ulcer bleeding were randomly divided into the control group and the observation group with 181 ones in each. The control group was treated by omeprazole 40mg in 0. 9% sodium chloride injection 100ml, ivd, bid, and the observation group was given pantoprazole 80mg in 0. 9% sodium chloride injection 100ml, ivd, bid. The treatment course was 3-6 days. The times of vomiting and melena, bleeding situation and bleeding stopping time in the two groups were observed and recorded, and the clinical efficacy, adverse drug reactions during the treatment and the expense of the two groups were also compared. Results:The bleeding amount on the first and third day in the observation group was significantly lower than that in the control group (P 0. 05). The average daily cost of the observation group was significantly lower than that of the control group (P 0. 05). Conclusion:The efficacy of omeprazole and pantoprazole in the treatment of peptic ulcer bleeding was similar with high security. However, pantoprazole may reduce the times of vomiting and melena, shorten the bleeding time and decrease the treatment cost.

A Case of Double Pylorus Presenting with Ulcer Bleeding / 이화의대지

Double pylorus is one of the rare anomalies of gastrointestinal tract, which have an accessory canal connecting the distal stomach to the duodenal bulb. The majority of the cases is thought to be acquired lesions from ulcer disease except some congenital cases. We report a case of a 77 year-old male who was visited the hospital because of the melena and diagnosed double pylorus. The relevant literatures on subject were reviewed.

Acute myocardial infarction coincident with gastric ulcer bleeding following herbal medication-induced acute renal failure / 대한내과학회지

Acute renal failure, acute myocardial infarction (AMI), and gastric ulcer bleeding (GUB) are associated with high rates of morbidity and mortality, especially in older patients. The development of each of these conditions can be followed by the development of another; however, it is rare for these three conditions to develop concurrently. Here, we report the case of a 92-year-old man who was admitted because of generalized weakness that developed after the ingestion of nothing but functional foods, including herbal medications containing Glycyrrhiza and Aloe, for ten days. After admission, AMI and GUB developed approximately six hours apart. Conservative treatment was chosen for the bleeding ulcer because of the high procedural risk, and the use of antiplatelet agents and heparinization for treatment of the infarction were stopped. The patient remained hemodynamically stable following the administration of a statin, diuretics, and proton pump inhibitors. A healed scar at the site of the ulcer was confirmed three weeks later; however, postinfarct angina developed after the patient's last endoscopy. Percutaneous coronary intervention was successfully performed with two stents placed in the left anterior descending artery.

Comparison of Clinical Characteristics and Outcomes between Geriatric and Non-geriatric Patients in Peptic Ulcer Bleeding / 대한소화기학회지

BACKGROUND/AIMS: In geriatric patients with peptic ulcer, the use of NSAID and prevalence of chronic illness have been increased, but the Helicobacter pylori (H. pylori) infected portion decreased. The aim of this study was to evaluate the clinical characteristics and outcomes of geriatric patients (aged 65 or older) with peptic ulcer bleeding and compare with non-geriatric patients (less than 65 years old). METHODS: We conducted a retrospective study of 88 patients with peptic ulcer bleeding treated with therapeutic endoscopy from January 2006 to December 2006. We compared the clinical characteristics and outcomes of geriatric patients (n=34, 38.6%) with those of non-geriatric patients (n=54, 61.4%). RESULTS: Hypertension (52.9% vs. 24.1%), cardiovascular disease (35.3% vs. 13.0%), and chronic obstructive pulmonary disease (20.6% vs. 3.7%) were more prevalent in the geriatric group, compared with the non-geriatric group (p0.05). The amount of transfusion length of ICU stay, rebleeding rate, operation rate and mortality were not different between the two groups. The length of hospital stay in the geriatric patients was significantly longer than the non-geriatric group (12.3+/-10.6 vs. 7.2+/-5.9 days, p<0.05). In multiple regression analysis, old age was a significant risk factor for longer hospital stay (p<0.05). CONCLUSIONS: The geriatric patients with bleeding peptic ulcer had longer hospital stay than the non-geriatric patients in our study. The important emerging etiologies such as ulcerogenic drug and associated chronic illness should be checked and treated in these patients.

Predictors of Rebleeding after Hemoclip Therapy for Treating High-risk Bleeding Ulcers: Hemoclip Therapy Alone was Comparable to Combination Treatment with Epinephrine Injection / 대한소화기내시경학회지

BACKGROUND/AIMS: Active bleeding and non-bleeding visible vessels in patients with bleeding peptic ulcer are associated with a high risk of rebleeding. The aim of our study was to define the risk factors associated with failure of endoscopic hemostasis and rebleeding in patients with active peptic ulcer bleeding. METHODS: We retrospectively reviewed 119 patients (90 men and 29 women; mean age, 60.14+/-14.67 years) with active peptic ulcer bleeding (spurting, oozing and/or non-bleeding visible vessel) and who were treated in Wonkwang Medical Center from January 2002 to January 2007. They were classified to endoscopic hemoclipping alone group (n=75) or endoscopic hemoclipping combined with epinephrine injection group (n=44), according to the therapeutic modality. RESULTS: Initial hemostasis was achieved in the two groups (100%), and permanent hemostasis was achieved 71.4% in all the patients. Operation was done in eight patients (6.7%), and six patients (5%) in the two groups, respectively, died within 1 month after initial hemostasis because of bleeding related complications. Recurrent bleeding, the duration of the hospital stay, blood transfusion requirements, complications and the operation and mortality rates were not statistically different between the hemoclip alone and combination groups. Univariate analysis showed that rebleeding was related to the presence of shock on admission (p=0.01), complication (p=0.00), the pulse rate (<100/min) on admission (p=0.04), single ulcer (p=0.032), the level of hemoglobin (<8 g/dL) (p=0.02) and the volume of transfusion (<3 units) after the procedure (p=0.005) in all the patients. On the multivariate analysis that was adjusted for age and gender, the hemoglobin level (<8 g/dL) (odds ratio = 10.5) was the only significant predictor for early rebleeding. CONCLUSIONS: This result may suggest that the combination method does not provide a substantial advantage over hemoclipping alone for the hemostatic management of active peptic ulcers bleeding. A low hemoglobin level on admission may be useful to predict rebleeding after initial endoscopic hemostasis in patients with active peptic ulcer. However, this study was designed retrospectively, so the comparison between these two groups should be re-evaluated prospectively in a large, multicenter trial.