Omeprazole versus histamine H2 receptor antagonists in the treatment of acute upper non-variceal bleeding.

BACKGROUND/AIMS: To compare the efficacy of omeprazole, a proton pump inhibitor, with Histamine H2 receptors antagonists in the control and recurrence of non-variceal upper gastrointestinal bleeding.

PATIENTS AND

METHODS

Seventy-one patients (Group A, Omeprazole) with definite diagnosis of upper gastrointestinal bleeding of non-variceal origin during January 1993-Dec.1994, compared retrospectively with 119 patients (Group B, Ranitidine) with similar criteria during 1987-1993. Patients in both groups were matched as compared to sex, age and risk factors. Active treatment was omeprazole 40 mg B.D (twice daily) and then orally in group A compared with ranitidine intravenously 50mg TDS (three times daily) and then 150 mg B.D orally in group B. All patients in both groups had endoscopy at the time of presentation or within 24 hours. Endoscopic treatment was applied in some of the patients to arrest acute bleeding. The efficacy of treatment was gauged by the number of blood transfusions needed to maintain Hb., evidence of re-bleeding and need for surgery.

RESULTS

The patients were well matched for endoscopic diagnosis except duodenal ulcers, which were more common in group A (P < 0.05). In group A out of 71 patients, 5 had rebleeding and 2 required surgery. In group B, out of 119 patients 12 rebled and 10 required surgery. Statistically there was no difference between groups (p = 0.52 by using Kendall's Tau B). Nine patients in omeprazole group received 2 units blood transfusion, 6 patients > 4 units and 3 patients > 6 units, while in the H2 blocker group, 16 patients received 2 units, 15 patients received > 4 units, and 3 patients > 6 units of blood transfusion. Statistically there was no difference between groups with regard to number of transfusions, rebleed or the need for surgery.

CONCLUSIONS

In our study we found no difference between omeprazole and histamine H2 receptors antagonists in controlling and recurrence of upper gastrointestinal bleeding.