Aim: the efficacy of Helicobacter Pylori eradication in prevention of peptic ulcer recurrence have been verified in different investigations but it's efficacy in preventing of early re bleeding in comparison with PPI infusion has not been elucidated. The aim of this study is comparison of efficacy of these two therapeutic modalities in patients with peptic ulcer bleeding.
Method: the bleeding peptic ulcer patients who have stigmata of recent bleeding like active spurting ( Forrest IA), non bleeding visible vessel ( Forrest IIA), oozing or adherent clot with visible vessel ( Forrest IA, IB, IIA) were included in study.
Design:after achieving endoscopic homeostasis with epinephrine injection (1:10000) plus APC or bipolar ECT, 2 samples from antrum and 2 from corpus will obtain by forceps biopsy. The samples will check for rapid urease test and all of the positive samples randomly, according to balance block render and with submitting confounding factors like age, sex and endoscopy results divided to 2 groups.
Intervention:
The group P treat with 80mg IV pantoprazol as bolus and then continuous IV infusion 8mg/h for 48h. The group H have receiv H. pylori eradication regimen including Omeprazole 20mg BID, tetracycline 1000mg BID, metronidazole 500mg BID and bismuth subcytrate 240mg BID for 14 days.
Inclusion/exclusion criteria :
The bleeding peptic ulcer patients with age ≥ 16 y old who had stigmata of recent bleeding .The exclusion criteria include esophageal varices, liver cirrhosis, malignancy, concomitant morbidity, cardiac pacemaker, NSAID consumption, current therapy with anti coagulant, antibiotic or PPI and multiple ulcers.
Outcome:the primary and secondary outcomes define according to rate of re bleeding, need to surgery, number of transfusions and duration of hospitalization in the first week and first month.The patients risk score will determine according to Rockall score and re bleeding define as hematemesis, repeating melena, >2gr/dl decrease in Hb level, pulse rate > 90/min or sudden drop in blood pressure