Inhibidores de la bomba de protones (IBP) y la hemorragia por úlcera péptica aguda: eficacia de esomeprazol por vía oral versus omeprazol por vía intravenosa en la reducción del riesgo de sangrado recurrente

BACKGROUND AND AIM: Endoscopic therapy is a safe and effective method of treating acute ulcer bleeding. However, failure of therapy, in terms of rebleeding, is seen in 15 to 20 % of patients. The use of intravenous high dose of a PPI has been shown to reduce frequency of rebleeding after endoscopic treatment. We have compared this therapy with a cheaper and easier oral administration of a newer powerful PPI. MATERIAL AND METHODS: A prospective randomized controlled trial has been conducted in patients referring to our Unit for non–variceal upper gastrointestinal bleeding between January and September 2003, and showing high risk of rebleeding endoscopic stigmata (HRS) (Forrest Ia, Ib, IIa, IIb). All patients were treated with 1/10000 adrenaline injection, haemoclips or combined methods. After endoscopic therapy they were randomly assigned to receive either intravenous omeprazole as a 80 mg bolus, followed by 40 mg three times daily for 72 hours, or esomeprazole 40 mg orally two times daily for 72 hours. After this period all patients were given respectively 20 mg of omeprazole or 40 mg of esomeprazole orally per day for four weeks. Outcome measures were recurrent bleeding and need of surgery. RESULTS: We enrolled consecutively 87 patients, 42 in the omeprazole intravenous group and 45 in the esomeprazole oral group. The two groups were homogeneous regarding to age, sex and HRS distribution (overall: 13 FIa, 17 FIb, 24 FIIa, and 33 FIIb). Seven second endoscopic treatments were necessary during the hospitalization (3 in the omeprazole group and 4 in the esomeprazole group). No patient underwent surgery. CONCLUSIONS: Our study confirms that after endoscopic treatment of bleeding peptic ulcer, a high dose of PPI reduces risk of recurrent bleeding, need for surgery and mortality. The oral administration of esomeprazole is as effective and safe as the intravenous omeprazole with a more simple way of administration and a lower drug cost.