PPI dose in UGI bleed

In this RCT, patients with an UGI bleed and high risk of recurrent bleeding (active bleeding, visible vessel, or adherent clot) recieved either high dose PPI (80mg bolus, then 8mg/hr for 3 days) or standard dose PPI (40mg bolus qday for 3 days). There was no difference between the groups in re-bleeding or units of transfused blood, but the standard dose group was much more likely to have a LOS <5 days. This indicates that standard dose PPI is not only clinically equivalent to high dose PPI therapy in reducing re-bleeding in high risk patients, but that it is also logistically preferable (abstract), as an accompanying editorialist agrees (editorial)

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

1 Comment

  1. James J. Miller M.D. on December 9, 2008 at 12:39 pm

    I only read the abstract. I didn’t have time for the fulltext. I like the spirit of the article. But I am apprehensive about putting it into practice without additional consensus from the practicing gastroenterology and hospitalist community as well as additional literature. I am curious as to how others feel. I am also curious as to how people will respond in the clinical setting where a patient is continuing to bleed in spite of the 40-mg daily bolus.

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