Effect of High-dose Oral Rabeprazole on Recurrent Bleeding After the Endoscopic Treatment of Bleeding Peptic Ulcers
Effect of High-dose Oral Rabeprazole on Recurrent Bleeding After the Endoscopic Treatment of Bleeding Peptic Ulcers
This study is conducted to compare and evaluate the effect of administering a high-dose
 intravenous proton pump inhibitors or high-dose oral Rabeprazole in preventing recurrent
 bleeding after the endoscopic treatment of bleeding peptic ulcers.
0.1 % of hospitalized patients are attributed to upper gastrointestinal bleeding every year
 in the U.S. and Europe, among which peptic ulcer is the most common cause of upper
 gastrointestinal bleeding. Endoscopic hemostasis procedure in the management of bleeding due
 to peptic ulcers was safe as well as effective and lowered recurrent bleeding, surgery and
 mortality. Endoscopic treatment is widely used as an effective and safe method but it has
 disadvantages including the need for the endoscopy specialist and the likelihood of
 developing the complications such as perforation or recurrent bleeding although they rarely
 occur. Thus, less invasive medical treatments with fewer side effects have been continuously
 studied and among them, gastric acid inhibitors have been studied the most.Acid and pepsin
 inhibit platelet aggregation, activation of blood coagulation system, and fibrinogen
 polymerization. Blood clots already formed are digested by pepsin and the activity of pepsin
 is closely related to intragastric pH level. Therefore, it is known that an elevated
 intragastric pH facilitates hemostasis process, induces hemostasis by stabilizing hematoma
 and prevents recurrent bleeding. To suffice these conditions, it is reported that a potent
 gastric acid inhibitor is needed to maintain intragastric pH of 6 or higher.

 For the treatment of bleeding peptic ulcers, the intravenous administration of a high-dose
 proton pump inhibitor after the initial endoscopic treatment has shown a decline in the
 frequency of recurrent bleeding as well as surgery. Recent studies reported that the use of
 oral proton pump inhibitor was effective under certain circumstances in the treatment of
 bleeding peptic ulcers. However, to date, no study has been conducted to compare the effect
 of a high-dose intravenous proton pump inhibitor with that of oral Rabeprazole after
 endoscopic treatment of bleeding peptic ulcers. Therefore, in this study, after administering
 a high-dose intravenous proton pump inhibitor or high-dose oral Rabeprazole in preventing
 recurrent bleeding following endoscopic treatment of bleeding peptic ulcers, we are going to
 compare the rate of recurrent bleeding between the two groups as well as to compare and
 evaluate the surgery rate, mortality rate and the number of days of hospital stay.
Inclusion Criteria:

 -  Bleeding peptic ulcer: Among patients suspected to have upper GI bleeding based on
 hematemesis or melena, those with peptic ulcers(Forrest I, IIa and IIb) in whom active
 bleeding, non-bleeding visible vessels and fresh blood clots are observed on upper GI
 endoscopy performed within 24 hours after the hospitalization

 -  patients who achieved primary hemostasis with endoscopic hemostasis procedure via
 upper GI endoscopy

 Exclusion Criteria:

 -  Patients who refuse endoscopic procedure

 -  Patients with complications from gastric ulcer that require operative treatment prior
 to upper GI endoscopic treatment(e.g., gastric outlet obstruction, peptic ulcer
 perforation)

 -  Pregnancy

 -  Patients with serious concurrent diseases such as malignant tumors or end-stage
 diseases

 -  History of previous gastrectomy or vagotomy

 -  Known hypersensitivity to proton pump inhibitors

 -  Elderly patients

 -  Epilepsy