A single-blinded multicenter randomized trial analyzed 124 patients after successful endoscopic hemostasis for high-risk peptic ulcer bleeding. Oral omeprazole 40 mg twice daily was compared with continuous intravenous pantoprazole 8 mg/h for 72 hours. Rebleeding at 72 hours and 30 days was not clearly different, although confidence intervals were wide.
Key findings
- Rebleeding by 72 hours occurred in 1/61 (1.6%) oral-treatment patients and 3/63 (4.8%) intravenous-treatment patients, a risk difference of −3.1 percentage points (95% CI −11.6 to 4.6). At 30 days, rates were 3.3% versus 4.8% (risk difference −1.5; 95% CI −10.1 to 7.0). Gastric-pH monitoring was completed in only 55 patients; median time with pH>6 was 56.3% versus 27.3% (p=0.064).
Why this matters globally
If oral therapy proves adequate in appropriate patients, it could reduce the complexity of continuous intravenous infusion and support resource-limited services. Clinical policy, however, must consider the total evidence and individual patient condition.
Thai researcher contribution
Teams from Chulalongkorn University, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, and Surin Hospital conducted a multicenter trial addressing a clinically and operationally important treatment question.
Limitations to consider
Few rebleeding events produced wide confidence intervals that do not exclude clinically meaningful differences. Gastric pH was measured in fewer than half of each group, and single blinding may permit bias. Results apply only after successful endoscopic hemostasis and should not support self-directed medication changes.
Verify the original sources
Journal of Gastroenterology and HepatologyRead the original article↗DOI: 10.1111/jgh.70566