الفهرس 
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Abstract
the outcome of our study patients treated with oral omeprazole was better than that of patients who received IV omeprazole. However, this conclusion must be considered in light of higher frequency of some risk factors for rebleeding among the patients of IV group. We expected to get an equal outcome for the two groups, as the superiority of IV omeprazole can compensate for the higher frequency of some risk factors for rebleeding among the patients of this group. Surprisingly, the outcome was worst among the patients of IV group which infers that oral omeprazole cannot be labeled as “inferior” to IV omeprazole regarding control of PUD bleeding and minimizing rebleeding, if not being superior. The limitations of our study included absence of blinding and lack of randomization regarding the different endoscopic tools used for hemostasis. However, using omeprazole produced by a single pharmaceutical company was a point of strength. Encourage the use of oral PPI for patients with bleeding PUD, even the high-risk ones, which will provide similar, or might be better, outcome with less cost and the least possible adverse effects, combined with better convenience for the patients and nursing staff. We recommend further studies with larger sample size, blinding, randomization of endoscopic tools for hemostasis, and using different agents of PPI group. The current study was performed at AL-Rajhi Liver Hospital during the period between December 2019 and November 2020. The study included 189 patients with bleeding PUD; they were randomized into two arms (one for oral omeprazole and the other for IV omeprazole). The mean age of oral group was significantly lower in comparison to the IV group, with male gender predominance among the patients of both groups. The frequency of IHD and history of PUD was significantly higher among the IV group. Single and small ulcer was the most frequent endoscopic finding. with Forrest class IIb as the most frequent class. Bleeding severity and risk stratification (represented by shock, lower hemoglobin level, higher Rockall score, and more blood transfusion) was significantly higher among the patients of the IV group compared to those of the oral group The most frequent reported site of the ulcer was the duodenum (46.9% in oral group vs. 51.6% in IV group). Eighteen patients of the oral group and 24 patients of the IV group had ulcers at more than one site. Adrenaline injection and clipping were performed in 9 (10%) and 33 (36.7%) patients of the oral group and 6 (%) and 15 (%) patients of the IV group, respectively. Twenty-seven (30%) and 36 (40%) patients of oral and IV group, respectively suffered from re-bleeding, while 3 (3.1%) and 15 (16.1%) patients of both groups, respectively required second endoscopic look. Only three (3.2%) patients in the study population (from IV group) required surgical intervention while 27 (29%) patients in IV group and 30 (31.3%) patients in oral group underwent angioembolization. Patients of IV group were significantly, more frequently admitted to ICU in comparison to oral group (74.2% vs. 59.4%; p= 0.02). Also, hospital stay was insignificantly longer among IV group (7.94 ± 4.81 vs. 6.34 ± 1.89 (day); p= 0.003). Three patients died secondary to the bleeding in each group. There were another six patients from the IV group were died secondary to other causes (three patients with pneumonia, another three patients with myocardial infarction).