Reviewer's report 
 A comparison of oral omeprazole and intravenous cimetidine in reducing complications of Title: 
duodenal peptic ulcer 
 2  11 August 2005 Version: Date: 
 Marika Mikelsaar Reviewer: 
Reviewer's report: 
General 
This study did not provide any new theoretical approaches as the effect of omeprazole in emergency 
situations (bleeding ulcer) has been proved. The authors also state it quite clearly in their 
Introduction, describing “Omeprazole as PPI prevents re-bleeding by increasing gastric pH and 
stabilizing the blood clot”. 
It is also well-known that H2 blockers can be efficiently used to facilitate the healing of duodenal ulcers during the long-lasting course of disease yet they are not usually applied in emergency 
situation. 
Practical approach: However, as seemingly in many developing/non-industrialised countries the 
main choice of medicines depends on the cost-efficacy of the drugs, cimetidine/ranitidine seems to 
be widely used in gastroenterology. 
The value of the study is that the authors have now clearly shown that cimetidine has no proof for 
application in complicated with bleeding peptic ulcer. The high rate of re-bleeding (50%) should 
warn practitioners. 
The extraordinary high rate of re-bleeding in cimetidine group seemingly depends on the selection of 
patients. It can be supposed that in developing countries only serious disease will drive a person to 
get help from hospital. 
The aim of the study is well defined. 
The study groups are well characterized and the patients are recruited in sufficient numbers. The results are clearly presented. 
Discussion starts with an interesting but non-substantiated claim about differences in parietal cell 
mass reduction by omeprazole in Asians vs. Caucasians. However, the next sentences are not in accordance with this statement of the difference as in western community omeprazole acts quite 
similarly by supporting the blood clot. This paragraph needs rephrasing. 
Conclusions and aims are in good accordance and relevant. 
Yet, it seems the last sentence should clearly express the advantage of omeprasole suggesting its 
use in gastrointestinal bleeding cases never mind the cost. 
I suggest accepting the manuscript with minor revision. 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
Reviewer's report 
 A comparison of oral omeprazole and intravenous cimetidine in reducing complications of Title: 
duodenal peptic ulcer 
 2  11 August 2005 Version: Date: 
 Marika Mikelsaar Reviewer: 
Reviewer's report: 
General 
This study did not provide any new theoretical approaches as the effect of omeprazole in emergency 
situations (bleeding ulcer) has been proved. The authors also state it quite clearly in their 
Introduction, describing “Omeprazole as PPI prevents re-bleeding by increasing gastric pH and 
stabilizing the blood clot”. 
It is also well-known that H2 blockers can be efficiently used to facilitate the healing of duodenal ulcers during the long-lasting course of disease yet they are not usually applied in emergency 
situation. 
Practical approach: However, as seemingly in many developing/non-industrialised countries the 
main choice of medicines depends on the cost-efficacy of the drugs, cimetidine/ranitidine seems to 
be widely used in gastroenterology. 
The value of the study is that the authors have now clearly shown that cimetidine has no proof for 
application in complicated with bleeding peptic ulcer. The high rate of re-bleeding (50%) should 
warn practitioners. 
The extraordinary high rate of re-bleeding in cimetidine group seemingly depends on the selection of 
patients. It can be supposed that in developing countries only serious disease will drive a person to 
get help from hospital. 
The aim of the study is well defined. 
The study groups are well characterized and the patients are recruited in sufficient numbers. The results are clearly presented. 
Discussion starts with an interesting but non-substantiated claim about differences in parietal cell 
mass reduction by omeprazole in Asians vs. Caucasians. However, the next sentences are not in accordance with this statement of the difference as in western community omeprazole acts quite 
similarly by supporting the blood clot. This paragraph needs rephrasing. 
Conclusions and aims are in good accordance and relevant. 
Yet, it seems the last sentence should clearly express the advantage of omeprasole suggesting its 
use in gastrointestinal bleeding cases never mind the cost. 
I suggest accepting the manuscript with minor revision. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
Please review this paper.
user
Reviewer's report 
 A comparison of oral omeprazole and intravenous cimetidine in reducing complications of Title: 
duodenal peptic ulcer 
 2  11 August 2005 Version: Date: 
 Marika Mikelsaar Reviewer: 
Reviewer's report: 
General 
This study did not provide any new theoretical approaches as the effect of omeprazole in emergency 
situations (bleeding ulcer) has been proved. The authors also state it quite clearly in their 
Introduction, describing “Omeprazole as PPI prevents re-bleeding by increasing gastric pH and 
stabilizing the blood clot”. 
It is also well-known that H2 blockers can be efficiently used to facilitate the healing of duodenal ulcers during the long-lasting course of disease yet they are not usually applied in emergency 
situation. 
Practical approach: However, as seemingly in many developing/non-industrialised countries the 
main choice of medicines depends on the cost-efficacy of the drugs, cimetidine/ranitidine seems to 
be widely used in gastroenterology. 
The value of the study is that the authors have now clearly shown that cimetidine has no proof for 
application in complicated with bleeding peptic ulcer. The high rate of re-bleeding (50%) should 
warn practitioners. 
The extraordinary high rate of re-bleeding in cimetidine group seemingly depends on the selection of 
patients. It can be supposed that in developing countries only serious disease will drive a person to 
get help from hospital. 
The aim of the study is well defined. 
The study groups are well characterized and the patients are recruited in sufficient numbers. The results are clearly presented. 
Discussion starts with an interesting but non-substantiated claim about differences in parietal cell 
mass reduction by omeprazole in Asians vs. Caucasians. However, the next sentences are not in accordance with this statement of the difference as in western community omeprazole acts quite 
similarly by supporting the blood clot. This paragraph needs rephrasing. 
Conclusions and aims are in good accordance and relevant. 
Yet, it seems the last sentence should clearly express the advantage of omeprasole suggesting its 
use in gastrointestinal bleeding cases never mind the cost. 
I suggest accepting the manuscript with minor revision. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
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