Follow-up endoscopy was scheduled at 2 mo, while on oral omeprazole (40 mg/d) to confirm ulcer healing. bleeding episode while on omeprazole. One patient discontinued the therapy and had recurrent bleeding. The median 24-h fraction time of gastric pH 4 in patients was 80, 46-95%, and was reduced to 32, 13-70% by omeprazole (eradication therapy and the use LY2090314 of potent proton pump inhibitors (PPIs) have dramatically reduced the need for surgical therapy of peptic ulcer disease. Still, about 10?% of duodenal ulcer patients undergo emergency surgical therapy for acute ulcer bleeding[1]. However, recurrent ulcer is not uncommon as it occurs in 10-15?% of patients after vagotomy and drainage and in 2-5?% of patients after gastric resection[2]. This may be complicated by life threatening acute recurrent ulcer bleeding in certain patients, requiring hospitalization. Several studies have investigated the rate of ulcer recurrence after duodenal ulcer surgery[2,3] and the completeness of vagotomy[4,5], but only a few studies have evaluated the anastomotic ulcer healing rates after being treated with H2 receptor antagonists (H2RA)[6,7] or PPI[8] therapy. Studies have shown that infection of the gastric mucosa is not related to ulcer recurrence after gastric surgery[4,9,10]. Furthermore, it has been shown that 28?% of anastomotic ulcers recur within 6 wk after discontinuing LY2090314 cimetidine therapy[7], and 33% relapse within a year while on cimetidine maintenance therapy[6]. These patients are often treated with a second operation[1]. However, to the best of our knowledge, there are no studies investigating the long-term outcome of patients with recurrent post-surgical ulcer and whether maintenance acid suppression therapy with PPIs may prevent recurrent ulceration and/or re-bleeding. Therefore, the present prospective open label study was conducted to investigate gastric pH profile and the effect of omeprazole maintenance therapy in patients presented with recurrent ulcer bleeding after duodenal ulcer surgical therapy. MATERIALS AND METHODS Over a 7-year period, this prospective open label study included 15 consecutive male patients admitted to our department due to recurrent acute ulcer bleeding. All patients underwent gastric surgery for duodenal ulcer disease at least 2 years ago. Clinical study In each case, emergency endoscopy was performed to confirm recurrent ulcer bleeding. The finding of an ulcer was considered as the bleeding cause if active bleeding or stigmata of recent hemorrhage were noted in the absence of other lesions. The recurrent ulcers were peristomal or duodenal in location. At the same time, detailed history was obtained about the indication and time of past gastric operation and the number of hospital admissions with hematemesis or melena after gastric surgery. History specifically included questions about the use of H2RA, PPIs or non-steroidal anti-inflammatory drugs (NSAIDs)[11], smoking and alcohol abuse. In all the patients fasting serum gastrin and salicylate concentrations were determined to exclude ZollingerCEllison syndrome and recent consumption of non-steroidal antiinflam-matory drugs. Patients who were on non-steroidal anti-inflammatory drugs were excluded. During endoscopy, multiple gastric Rabbit polyclonal to GNRHR mucosal biopsies were obtained to investigate infection. All patients were initially treated with intravenous omeprazole (20 mg every 12 h) and then orally after discharge from the hospital. eradication therapy was not used to prevent ulcer recurrence[10,12], but was eradicated in two patients because of severe gastritis. Follow-up endoscopy was scheduled at 2 mo, while on oral omeprazole (40 mg/d) to confirm ulcer healing. Thereafter, the patients were instructed to receive oral omeprazole (20 mg/d) maintenance therapy, to avoid the use of any non-steroidal anti-inflammatory drugs and to have follow-up every 6 mo as outpatients. Twenty-four-hour gastric pH studies Twenty-four-hour gastric pH studies were performed in the following groups on omeprazole therapy (20 mg/d) LY2090314 but not on antisecretory therapy: patients with LY2090314 first or second degree reflux esophagitis (Los Angeles classification) (normal controls); patients with duodenal ulcer; controls who underwent vagotomy.