Hydrogen peroxide improves the visibility of ulcer bases in acute non-variceal upper gastrointestinal bleeding: A single-center prospective study

Subbaramiah Sridhar, Sherman M Chamberlain, Dharma S Thiruvaiyaru, Sankara N Sethuraman, Jigneshkumar Patel, Moonkyung Schubert, Francisco Cuartas-Hoyos, Robert Schade

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Acute non-variceal upper gastrointestinal bleeding (ANVB) or hemorrhage (used interchangeably) is an emergency. Endoscopically applied hydrogen peroxide (H2O2) has been shown to improve visualization of the ulcer base. Aims: To test the hypothesis that ulcer base clot clearance with 3% H2O2 improves the visualization of ANVB lesions compared to water alone. Methods: In this single-center prospective study, 320 patients with ANVB were examined, of which 81 met the entry criteria for evaluation. All patients with ANVB underwent urgent endoscopy. Those with adherent clots on the ulcer base were sprayed with 250 ml of water, followed by up to 100 ml of 3% H2O2. The main outcome measurement was Kalloo's Visual Scores of the ulcer base before and after water and H 2O2. Results: Eighty-one patients with gastric ulcers (GU; 34) and duodenal ulcers (DU; 47) met the entry criteria. The mean improvement in grade from water to H2O2 was 2.04 (95% confidence interval [CI] (1.86, 2.23)). The mean volume of H2O2 used to clear clots was higher (70 ml) in patients who were negative for both Helicobacter pylori and non-steroidal anti-inflammatory drug (NSAID) use than in those who were positive for both (31 ml) (P = 0.00). More DU patients (72%) had visible vessels than GU patients (44%) (P = 0.01). Conclusions: H 2O2 improved the visualization of ulcer bases in ANVB. A smaller volume of H2O2 was required to clear clots in patients who used NSAIDs and had H. pylori infection. H2O2 identified more DU vessels. The use of H2O2 should be considered as a standard therapy in the management of clots in ANVB.

Original languageEnglish (US)
Pages (from-to)2427-2433
Number of pages7
JournalDigestive Diseases and Sciences
Volume54
Issue number11
DOIs
StatePublished - Nov 1 2009

Fingerprint

Hydrogen Peroxide
Ulcer
Prospective Studies
Hemorrhage
Water
Helicobacter pylori
Helicobacter Infections
Non-Steroidal Anti-Inflammatory Agents
Stomach Ulcer
Duodenal Ulcer
Endoscopy
Emergencies
Anti-Inflammatory Agents
Confidence Intervals
Pharmaceutical Preparations

Keywords

  • Endoscopy
  • Hydrogen peroxide
  • Non-variceal bleeding
  • Ulcer clot

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Hydrogen peroxide improves the visibility of ulcer bases in acute non-variceal upper gastrointestinal bleeding : A single-center prospective study. / Sridhar, Subbaramiah; Chamberlain, Sherman M; Thiruvaiyaru, Dharma S; Sethuraman, Sankara N; Patel, Jigneshkumar; Schubert, Moonkyung; Cuartas-Hoyos, Francisco; Schade, Robert.

In: Digestive Diseases and Sciences, Vol. 54, No. 11, 01.11.2009, p. 2427-2433.

Research output: Contribution to journalArticle

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title = "Hydrogen peroxide improves the visibility of ulcer bases in acute non-variceal upper gastrointestinal bleeding: A single-center prospective study",
abstract = "Background: Acute non-variceal upper gastrointestinal bleeding (ANVB) or hemorrhage (used interchangeably) is an emergency. Endoscopically applied hydrogen peroxide (H2O2) has been shown to improve visualization of the ulcer base. Aims: To test the hypothesis that ulcer base clot clearance with 3{\%} H2O2 improves the visualization of ANVB lesions compared to water alone. Methods: In this single-center prospective study, 320 patients with ANVB were examined, of which 81 met the entry criteria for evaluation. All patients with ANVB underwent urgent endoscopy. Those with adherent clots on the ulcer base were sprayed with 250 ml of water, followed by up to 100 ml of 3{\%} H2O2. The main outcome measurement was Kalloo's Visual Scores of the ulcer base before and after water and H 2O2. Results: Eighty-one patients with gastric ulcers (GU; 34) and duodenal ulcers (DU; 47) met the entry criteria. The mean improvement in grade from water to H2O2 was 2.04 (95{\%} confidence interval [CI] (1.86, 2.23)). The mean volume of H2O2 used to clear clots was higher (70 ml) in patients who were negative for both Helicobacter pylori and non-steroidal anti-inflammatory drug (NSAID) use than in those who were positive for both (31 ml) (P = 0.00). More DU patients (72{\%}) had visible vessels than GU patients (44{\%}) (P = 0.01). Conclusions: H 2O2 improved the visualization of ulcer bases in ANVB. A smaller volume of H2O2 was required to clear clots in patients who used NSAIDs and had H. pylori infection. H2O2 identified more DU vessels. The use of H2O2 should be considered as a standard therapy in the management of clots in ANVB.",
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AU - Sridhar, Subbaramiah

AU - Chamberlain, Sherman M

AU - Thiruvaiyaru, Dharma S

AU - Sethuraman, Sankara N

AU - Patel, Jigneshkumar

AU - Schubert, Moonkyung

AU - Cuartas-Hoyos, Francisco

AU - Schade, Robert

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N2 - Background: Acute non-variceal upper gastrointestinal bleeding (ANVB) or hemorrhage (used interchangeably) is an emergency. Endoscopically applied hydrogen peroxide (H2O2) has been shown to improve visualization of the ulcer base. Aims: To test the hypothesis that ulcer base clot clearance with 3% H2O2 improves the visualization of ANVB lesions compared to water alone. Methods: In this single-center prospective study, 320 patients with ANVB were examined, of which 81 met the entry criteria for evaluation. All patients with ANVB underwent urgent endoscopy. Those with adherent clots on the ulcer base were sprayed with 250 ml of water, followed by up to 100 ml of 3% H2O2. The main outcome measurement was Kalloo's Visual Scores of the ulcer base before and after water and H 2O2. Results: Eighty-one patients with gastric ulcers (GU; 34) and duodenal ulcers (DU; 47) met the entry criteria. The mean improvement in grade from water to H2O2 was 2.04 (95% confidence interval [CI] (1.86, 2.23)). The mean volume of H2O2 used to clear clots was higher (70 ml) in patients who were negative for both Helicobacter pylori and non-steroidal anti-inflammatory drug (NSAID) use than in those who were positive for both (31 ml) (P = 0.00). More DU patients (72%) had visible vessels than GU patients (44%) (P = 0.01). Conclusions: H 2O2 improved the visualization of ulcer bases in ANVB. A smaller volume of H2O2 was required to clear clots in patients who used NSAIDs and had H. pylori infection. H2O2 identified more DU vessels. The use of H2O2 should be considered as a standard therapy in the management of clots in ANVB.

AB - Background: Acute non-variceal upper gastrointestinal bleeding (ANVB) or hemorrhage (used interchangeably) is an emergency. Endoscopically applied hydrogen peroxide (H2O2) has been shown to improve visualization of the ulcer base. Aims: To test the hypothesis that ulcer base clot clearance with 3% H2O2 improves the visualization of ANVB lesions compared to water alone. Methods: In this single-center prospective study, 320 patients with ANVB were examined, of which 81 met the entry criteria for evaluation. All patients with ANVB underwent urgent endoscopy. Those with adherent clots on the ulcer base were sprayed with 250 ml of water, followed by up to 100 ml of 3% H2O2. The main outcome measurement was Kalloo's Visual Scores of the ulcer base before and after water and H 2O2. Results: Eighty-one patients with gastric ulcers (GU; 34) and duodenal ulcers (DU; 47) met the entry criteria. The mean improvement in grade from water to H2O2 was 2.04 (95% confidence interval [CI] (1.86, 2.23)). The mean volume of H2O2 used to clear clots was higher (70 ml) in patients who were negative for both Helicobacter pylori and non-steroidal anti-inflammatory drug (NSAID) use than in those who were positive for both (31 ml) (P = 0.00). More DU patients (72%) had visible vessels than GU patients (44%) (P = 0.01). Conclusions: H 2O2 improved the visualization of ulcer bases in ANVB. A smaller volume of H2O2 was required to clear clots in patients who used NSAIDs and had H. pylori infection. H2O2 identified more DU vessels. The use of H2O2 should be considered as a standard therapy in the management of clots in ANVB.

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