OUTCOME OF ORAL VS. INTRAVENOUS ESOMEPRAZOLE IN BLEEDING PEPTIC ULCER (SRH+) AFTER ENDOSCOPIC TREATMENT

Context: Peptic ulcer disease is the most common cause of upper gastrointestinal bleed and a common problem in the emergency department. Approximately a third of the patients with significant ulcer bleeding will develop recurrent bleeding on long-term follow-up, in the absence of active intervention . Although endoscopic hemostasis reduces mortality, acid suppression not only helps in achieving hemostasis but also reduces rebleeding . Aims: To study the outcome of Oral vs. Intravenous esomeprazole in bleeding peptic ulcer (SRH+) after endoscopic treatment in terms of rebleeding and in increasing the intraluminal pH . Materials and Methods: About 200 patients with upper gastrointestinal bleeding presenting with malena or hemetemesis or both were enrolled for the study. After endoscopic hemostasis , patients were randomized into two groups; one receiving oral esmoprazole and the other receiving intravenous (IV) esmoprazole. The primary end points were rate of rebleeding and secondary end points were surgery; number of deaths, duration of hospital stay, number of blood transfusions and number of rescue therapies required. The intragastric pH study was done in 20 patients; 10 patients on oral esomeprazole and 10 on IV esomeprazole. Results: The baseline characterstitics of patients including age, sex, previous peptic ulcer disease, concurrent illness, the severity of bleeding at presentation, sight and size of ulcer, use of NSAIDS and endoscopic findings were comparable in the two groups. Rebleeding occured in 25 patients (12.5%); 14 patients (13.86%) in oral group and 11 patients (11.11%) in IV group. Emergency surgery was required in 7 (6%) patients in oral esomeprazole group as compared to 5(5%) patients in esomeprazole group. The mean number of patients who received blood transfusion were 9 (8.9%) in oral esomeprazole group and 11 (11.11%) in IV esomeprazole group. The total duration of hospital stay in oral group was 3.60+1.72 vs. 3.47+1.30 in IV group. The mean 72 hrs. intragastric pH in oral esomeprazole group was 7.06+0.44 and 6.78+0.27 in IV esomeprazole group. Conclusions: Both oral and intravenous esomeprazole given to patients of bleeding peptic ulcers with SRH after endoscopic hemostasis had a similar effect on both the primary and secondary end points.