- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00471029
Compare Efficacy of Gastric Acid Suppression by Oral and Intravenous Administration of Esomeprazole in Patients With Peptic Ulcer (NPH)
Compare Gastric Acid Suppression of Esomeprazole by Oral or Intravenous Administration - A Randomized Trial
Study Overview
Detailed Description
Peptic ulcer bleeding is a common medical emergency. Although primary hemostasis can be achieved by endoscopic hemostasis in more than 90% of cases, rebleeding during the first 72 hours is still common. The use of secretory inhibitors in ulcer bleeding had theoretical benefit in preventing rebleeding. In vitro, platelet aggregation and disaggregation, coagulation and fibrinolysis are strongly dependent on intra-gastric pH. When pH falls below 6.0, platelet disaggregation takes place and below 4.0, fibrin clots dissolved. Pharmacological studies have clearly shown that primed proton-pump inhibitor (PPI) infusion is superior to H2-receptor blocler (H2B) injection or infusion in maintaining high intra-gastric pH. Randomized trials had demonstrated the advantage of adjuvant use of intravenous or oral PPI in reducing rebleeding as compared to placebo. However, as Asian subjects generally have lower body weight and acid output than Caucasians, the dosage of PPI required for prevent rebleeding may be different. Lin et al had demonstrated that in an Asian population study, in order to show a significant clinical effect in prevent peptic ulcer rebleeding after endoscopic hemostasis, at least a 30% difference in duration in maintaining an intragastric pH >6 must be achieved. As there is substantial cost implication of routine use of high dose intravenous PPI infusion (80mg bolus + 8mg/hour for 72 hours, cost ~HKD$1100) against high dose oral esomeprazole (40mg BD for 3 days, cost ~HKD$60), the optimal doses and routes of administration of PPI in achieving effective acid suppression is needed to be clearly defined.
Protocol:
Patients presented with bleeding peptic ulcers (melena, hememtesis) will undergo endoscopy. If clean base peptic ulcer which dos not require endoscopic treatment is diagnosed, consented patients will randomly allocated into 2 groups using sealed envelopes containing a therapeutic option derived from a randomized table.
- Esomeprazole infusion (80mg bolus then 8mg/hour) (192mg/d)
- Esomeprazole Tablet oral 40mg 12 hourly (80mg/d)
A pH electrode with internal reference (Synetic) was inserted transnasally and positioned 10cm below the cardia. It was calibrated before and after the pH recording with standard buffer solutions of pH 7.00 and pH 1.00. The electrode was connected to a data logger (Mircodigitrapper, Synetic). At the end of 24hours recording, the data were transfer to a personal computer for analysis. Medication will be given after insertion of intra-gastric pH monitor probe.
Outcome measures Primary Outcome: total % Time pH > 6 & 4 Secondary outcome: Median intragastric pH & Time to reach pH 4 and 6
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Simon K.H. Wong, MBChB, FRCSEd, FHKAM
- Phone Number: 852-25956416
- Email: wongkhmo@netvigator.com
Study Locations
-
-
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Hong Kong, China
- Recruiting
- Pamela Youde Nethersole Eastern Hospital
-
Principal Investigator:
- Simon KH Wong, MBChB
-
Contact:
- Simon KH Wong, MBChB
- Email: wongkhmo@netvigator.com
-
Sub-Investigator:
- Michael KW Li, MD
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Sub-Investigator:
- Geroge PC Yang, MBBS
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients with non-bleeding peptic ulcer which do not require endoscopic therapy.
- Chinese, Age ³18 and <90
- Provision of an informed written consent signed by the patient.
Exclusion Criteria:
- Treatment of antisecretory drugs during the preceding 4 weeks
- The present inter-current ulcer complication (gastric outlet obstruction or ulcer perforation)
- Presence of esophageal / gastric varices
- aspirin or NSAID user
- Pregnancy
- Age <18 or >90
- Moribund patients, patients with severe liver or renal disease
- Known sensitivity to proton pump inhibitors
- Previous gastric surgery (except simple patch repair)
- Patient unable to give written consent
- Special population, e.g. prisoner, mentally disabled, investigators' student or employees
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
percentage of time intragstric pH > 6 and > 4
Time Frame: 24hours after endoscopy
|
24hours after endoscopy
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Median intragastric pH
Time Frame: 24hours after endoscopy
|
24hours after endoscopy
|
time to attain intragastric pH 4 & 6
Time Frame: 24hours after endoscopy
|
24hours after endoscopy
|
Collaborators and Investigators
Investigators
- Principal Investigator: Simon K.H. Wong, MBChB, FRCSEd, FHKAM, Pamela Youde Nethersole Hospital - Surgery
- Study Chair: Michael K.W. Li, MD, PYNEH
Study record dates
Study Major Dates
Study Start
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- HKEC-2005-110
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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