In peptic ulcer bleeding (PUB), pH level >4 is considered necessary to prevent dissolving of a formed fibrin clot. The effect of regular or high doses of omeprazole on the intragastric pH in patients with acute PUB was studied.
In our earlier study, after endoscopic therapy, PUB patients were randomized to receive a regular dose of intravenous omeprazole (20 mg; i.e. 60 mg/3 days) or a high dose of omeprazole (80 mg bolus+8 mg/h; i.e. 652 mg/3 days). Of these 142 analysed and reported patients, 13 PUB patients also had intragastric pH monitoring for these 3 days; seven of these patients had a regular dose and six received a high dose of omeprazole.
The mean 24-h intragastric pH (regular versus high dose) on day 1 was 4.9±1.6 versus 6.3±0.5 (P=0.035), on day 2 was 4.9±1.8 versus 6.7±0.3 (P=0.001), and on day 3 was 5.7±1.1 versus 6.7±0.5 (P=NS). The medians of the intragastric pH were 6 versus 6.5 (P=0.082) on day 1, 5.8 versus 6.8 (P=0.001) on day 2, and 6.2 versus 6.8 (P=0.17) on day 3. The proportion of time when pH <4 on day 1 was 29.2±34.1 versus 5.4±5.7% (P=NS).
A regular dose of omeprazole raises the mean and median 24-h intragastric pH >4 in patients with PUB. This reduction in the acidity together with endoscopic therapy is probably sufficient to maintain haemostasis. A high dose of omeprazole keeps the pH almost constantly >6.
aDepartment of Surgery, Central Finland Central Hospital, Jyväskylä
bDepartment of Clinical Physiology and Nuclear Medicine
cDepartment of Surgery
eGastroenterology Unit, Department of Internal Medicine, Kuopio University Hospital, Kuopio
dDepartment of Surgery, Helsinki University Central Hospital, Helsinki, Finland
Correspondence and requests for reprints to Marianne Udd, Department of Surgery, Helsinki University Central Hospital, P.O. Box 340-00029 HUCH, Helsinki, Finland
Tel: +358 47172311; fax: +358 47175646;
Received 14 June 2005 Accepted 19 August 2005