Clinical alert
Intravenous omeprazole after endoscopic treatment of bleeding peptic ulcers
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Active ulcer bleeding can usually be stopped by therapeutic endoscopy but 15-20% of patients rebleed, usually within the first 24 hours. The rebleeding rate is similar for all endoscopic haemostatic modalities1 and combinations of endoscopic treatments are little better than single modalities.2 Patients who rebleed have a high risk of dying. Rebleeding occurs as the blood clot which is formed over the arterial defect within the ulcer base is either dislodged or dissolves. It is clear that blood clot stability is dependent on intragastric pH and below 5, clot lysis occurs due to the combined effects of trypsin and acid.3 A pH greater than 6 is necessary for optimum platelet aggregation. Thus powerful acid suppressing drugs by stabilising the arterial plug have the potential to reduce rebleeding rates and thereby improve prognosis.
In 1992 Daneshmend and colleagues4 reported an extremely
large randomised trial in which patients presenting acutely with gastrointestinal bleeding were administered
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