hold the PPI in GI Bleed?

25 Feb

interesting post from the Skeptic’s Guide to EM:


Does the use of PPIs (e.g. 80mg pantoprazole IV bolus followed by an 8mg/hr drip) prior to endoscopy in acute upper GI bleeds change patient oriented outcomes?




bleeding usually from peptic ulcer

seemed reasonable and has been common practice to lower the gastric acid


Mortality (six trials n=2223) NO DIFFERENCE

Rebleeding (five trials n=2,121) NO DIFFERENCE

Surgery (five trials n=2,165) NO DIFFERENCE

Active bleed at scope (four trials n=1,332) 8.6% PPI vs. 11.7% placebo


“Applying a costly treatment that does not seem to positively effect clinically important end points like mortality, need for surgery or re-bleeding does not seem wise.  Proton pump inhibitors may be required but this data does not support the routine use of them before endoscopy.”


References: post; picture


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