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.

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.

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.

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.

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..

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.

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.

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.

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.

Endoscopic treatment and pharmacologic therapy of peptic ulcer bleeding / 대한내과학회지

The incidence of peptic ulcer bleeding decreased slowly in duodenum, but slight rised in gastric ulcer. Endoscopic treatment is being performed as a treatment algorithms. Endoscopic treatment for ulcer bleeding has become a standard therapy with injections of epinephrine and saline solutions, thermocoagulation, mechanical devices such as hemoclips and banding ligator. With these treatment modalities, the mortality of nonvariceal bleeding decreased significantly during last 2 decades. Early intensive management could affect the therapeutic results. The time to hemodynamic stabilization correlated with mortality reduction. Combined endoscopic therapy is the treatment of choice for high-risk bleeding peptic ulcers. With the combined therapy, recurrent bleeding was reduced and surgery was obviated. Pharmacologic treatment with high-dose proton pump inhibitors stabilizes blood clot and has been proven to further improve the success of hemostasis. The studies using high-dose proton pump inhibitors as an adjuvant to endoscopic therapy, recurrent bleeding and surgery rate were reduced. Recently therapeutic effects of endoscopic treatment and pharmacologic management for peptic ulcer bleeding was published. Endoscopy was carried out within 24 hours in 86.6% of the patients. High risk endoscopic stigmata was reported in 70.7%. The rebleeding, surgery, and mortality rates were 4.5%, 0% and 0%, respectively. Proton pump inhibitor use and endoscopic combination therapy were associated with reduced rebleeding and mortality in patients with peptic ulcer bleeding.

A Case of Mucosal Necrosis of the Stomach after Endoscopic Injection Therapy with Hypertonic Saline-Epinephrine (HS-E) for a Bleeding Peptic Ulcer with an Exposed Vessel / 대한소화기내시경학회지

Peptic ulcer bleeding is a frequent cause of upper G-I bleeding. Endoscopic injection therapy with hypertonic saline-epinephrine (HS-E) is a cost-effective and widely used therapy for hemostasis; however, 1~3% of patients experience bleeding or perforation. A 70 year-old male patient was admitted with melena and hematemesis. An endoscopy on admission showed the presence of a 1 cm- sized well-demarcated ulcer with pulsatile bleeding at the lesser curvature of the distal antrum. Approximately 28 mL of HS-E solution was injected around the exposed vessel. Follow-up endoscopy performed 7 days later showed the presence of a 2 cm-sized newly developed mucosa necrosis at the lesser curvature of the pyloric channel, which was caused by ischemic necrosis of the gastric mucosa after HS-E injection. Endoscopic injection therapy with HS-E solution is a relatively safe technique, but mucosa necrosis can occur with the use of a dose of HS-E that is considered safe. We report a case of gastric mucosa necrosis following endoscopic HS-E injection therapy of a bleeding peptic ulcer.

Comparison of the hemostatic effect between argon plasma and heat probe for peptic ulcer bleeding / 대한내과학회지

BACKGROUND/AIMS: Endoscopic heat probe coagulation (HP) and argon plasma coagulation (APC) are considered to be safe and effective for the treatment of peptic ulcer bleeding. The aim of this study was to evaluate the efficacy and safety of APC and HP for treating bleeding peptic ulcer. METHODS: Between May 2004 and November 2006 we conducted a prospective randomized trial on 99 patients with peptic ulcer bleeding and for whom a visible vessel or active bleeding was identified. The patients were randomized into two groups: the APC group that was comprised of 56 patients who received argon plasma coagulation and HP group that was comprised of 43 patients who received heat probe coagulation. RESULTS: There were no significant differences between the study groups in terms of age, risk factors, the initial hemoglobin values, the number of patients who showed signs of hemodynamic impairment, the location of ulcer and the bleeding activity. The initial hemostatic rate was 89.3% in the APC group and 93% in the heat probe group (p=0.521). After successful initial endoscopic treatment, rebleeding was observed in 4 cases of the APC group (7.1%) and in 4 cases of heat probe coagulation group (9.3%). CONCLUSIONS: Argon plasma coagulation and heat probe coagulation are equally effective for controlling bleeding from peptic ulcer.

Clinical Usefulness of Proton Pump Inhibitor Intravenous Treatment in Bleeding Peptic Ulcer / 대한소화기내시경학회지

BACKGROUND/AIMS: Recently, high dose PPI intravenous (IV) infusion after endoscopic hemostasis was found to decrease the recurrent bleeding rate. Therefore, we conducted this study to define the effect of endoscopic hemoclipping with PPI IV infusion on the recurrent bleeding rate. METHODS: We conducted a double-blinded prospective randomized control study. A total of 35 patients were endoscopically diagnosed with bleeding peptic ulcer of Forrest classification Ia, Ib, IIa between Jan. 2003 and Sep. 2003 in our hospital. We carried out epinephrine injection therapy around the ulcer, followed by hemoclipping at the exposed vessel. After controlling for endoscopic bleeding, we randomly divided the patients into two groups. One group received a PPI IV infusion (pantoprazole 80 mg/day) and the other group received a placebo for three days. RESULTS: Only one PPI IV-infused patient and one patient receiving placebo showed recurrent bleeding at two days after endoscopic therapy. The PPI IV infusion group showed 100% (17/17) initial hemostatic rate, 5.8% (1/17) recurrent bleeding rate within 3 days, 0% (0/17) recurrent bleeding rate after 3 days, and 0% (0/17) complication rate. For these same values, the placebo group showed 100% (18/18), 5.5% (1/18), 0% (0/18), and 0% (0/18), respectively. CONCLUSIONS: PPI IV infusion showed no addictive hemostatic effect. We think hemoclipping is a very effective hemostatic method, and PPI IV infusion may not be required after appropriate endoscopic management

Comparison of Hemostatic Efficacy between Epinephrine Injection Alone and a Combined Therapy with Hemoclip for Bleeding Peptic Ulcers / 대한소화기내시경학회지

BACKGROUND/AIMS: Many studies have been performed to find the differences between using epinephrine injection alone and a combination therapy with hemoclip for bleeding peptic ulcer, but the results have been controversial. We retrospectively evaluated the hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip for bleeding peptic ulcers. METHODS: Four hundred patients were enrolled. They were assigned to one of the two groups: endoscopic hemostasis with injection of epinephrine (group I, n=156) and combined epinephrine injection with hemoclip (group II, n=244). RESULTS: The continuous bleeding rate was significantly higher in group I than in group II. The recurrent bleeding rate was also significantly higher in group I than in group II. There were no statistical differences in the rates of death, emergency surgery and arterial embolization. The rates of continuous bleeding and the initial failure of hemostasis were higher for the patients with active bleeding on the initial endoscopy irrespective of the applied hemostatic methods. CONCLUSIONS: A combination of epinephrine injection and hemoclip is more effective than epinephrine injection alone for treating bleeding peptic ulcers.

Controlled Comparison of Endoscopic Epinephrine Injection and Endoscopic Argon Plasma Coagulation for the Treatment of Acute Peptic Ulcer Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic injection therapy with hypertonic saline Epinephrine (HSE) is the easiest and most widely used procedure for the management of peptic ulcer bleeding. Argon plasma coagulation (APC) is a recently introduced endoscopic hemostatic procedure. Thus, we performed a prospective trial to compare the hemostatic efficacy of APC and HSE. METHODS: Forty patients with the diagnosis of bleeding ulcer were randomly assigned to receive either HSE (n=20) or APC (n=20) treatment during the period of September 2003 to April 2004. The two groups were matched for gender, age, site of bleeding, the endoscopic findings and the initial hemoglobin at the study baseline. RESULTS: The bleeding was initially controlled in 18 patients (90%) of the APC group, and in 20 patients (100%) of the HSE group. Rebeeding occurred in one patient (5%) of the APC group and in 3 patients (15.5%) of the HSE group. The lengths of stay in the hospital were 11.7 days in the APC group and 10.7 days in the HSE group. Death occurred in 1 case in the APC group and in 1 case in the HSE group. The initial hemostatic efficacy showed no difference between the two groups. CONCLUSIONS: Argon plasma coagulation is as effective as hypertonic saline epinephrine injection for the initial management of acute peptic ulcer bleeding.

Comparison of Hemostatic Effects between a Combination Therapy Including Endoscopic Injection Therapy and Omeprazole and a Single Intravenous Omeprazole Therapy in Patients with Bleeding Peptic Ulcers / 대한소화기내시경학회지

BACKGROUND/AIMS: This study was performed to test whether there is some difference between combined endoscopic therapy with PPI infusion and intravenous PPI therapy alone. METHODS: A total of seventy-three high-risk patients with ulcer bleeding and non-bleeding visible vessels or fresh adherent clots resistant to irrigation were randomized to medical therapy [intravenous omeprazole therapy alone: 40 mg IV per day for 3~5 days] or to endoscopic combination therapy [endoscopic epinephrine (1 : 10,000 in normal saline) or ethanol injection followed by intravenous omeprazole infusion]. RESULTS: Patients were similar at study entry. Ulcer bleeding recurred in two patients who received combined endoscopic therapy (2/35, 5.7%) while ulcer bleeding recurred in ten patients who received intravenous omeprazole alone (10/38, 26.3%) (p < 0.05). Two patients (2/35, 5.7%) in the combined therapy group and five patients (5/38, 13.2%) in the omeprazole infusion alone group had surgery for intractable bleeding (p=0.281). One patient in each group died within the hospital stays (p=0.953). CONCLUSIONS: The combination of endoscopic injection therapy with omeprazole infusion is superior to omeprazole infusion alone for preventing recurrent bleeding from ulcers with nonbleeding visible vessels or adherent clots.

The Effects of Endoscopic Sodium Alginate Powder (Alto Shooter(TM)) in Peptic Ulcer Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Peptic ulcer bleeding can be treated by endoscopic laser, argon plasma coagulation, heater probe, or electrocoagulation. However, techinical difficulties and significant rebleeding rate after such endoscopic hemostasis, offer some beneficial effect of Alto Shooter(TM) as an adjuvant therapy in active peptic ulcer bleeding. METHODS: Twenty-three patients with active peptic ulcer bleeding were randomized to Alto Shooter(TM) & argon plasma coagulation therapy (ALTO+APC) or argon plasma coagulation therapy alone (APC). Forrest classifications were used to compare the effect of bleeding control. RESULTS: The Forrest classifications in two groups before treatment were Ib (6 patients), IIa (11 patients) in "ALTO+APC", Ib (2 patients) and IIa (4 patients) in "APC". The Forrest classifications of two groups at follow-up endoscopy were Ia (1 patient), Ib (1 patient), IIc (14 patients), III (1 patient) in "ALTO+APC" and IIc (6 patients) in "APC". There was no significant difference in hemostatic effect between "ALTO+APC" (p=0.001) and "APC" (p=0.001) groups. CONCLUSIONS: Alto Shooter(TM) offers no advantage over conventional endoscopic argon plasma coagulation therapy in controlling active peptic ulcer bleeding. Therefore routine addition of Alto ShooterTM treatment may not be recommended after initial successful endoscopic argon plasma coagulation therapy in active peptic ulcer bleeding.