pH >= 6.0 required for platelet aggregation and clot stabilization
Rationale for 80 mg bolus + 8 mg/hr infusion regimen
Oral vs. IV PPI equivalence for stable patients post-endoscopy
High-bioavailability oral PPIs may be as effective as IV in non-critical patients
Endoscopic hemostasis evidence base
Combination therapy reduces rebleeding vs. monotherapy
Thermal + injection vs. injection alone: NNT approximately 7
OTSC as rescue device or primary therapy for high-risk stigmata
ESGE 2026 Guideline: OTSC recommended for Forrest Ia/IIa as alternative to combination
Prophylactic embolization post-endoscopy
Cochrane 2025: prophylactic TAE post-endoscopic control not superior to standard care
No reduction in rebleeding, mortality, or length of stay
TAE reserved for actual rebleeding, not prophylaxis
Somatostatin analogues
Octreotide not standard of care for non-variceal UGIB
Role limited to variceal bleeding and bridge to endoscopy
No benefit demonstrated for PUD-related bleeding
Secondary prophylaxis post-discharge
Maintenance PPI for all patients with NSAID requirement and history of UGIB
H. pylori eradication most important factor to prevent recurrence
Avoid NSAIDs; use celecoxib (selective COX-2) with PPI if NSAID unavoidable
Patient Discharge Instructions
copy discharge instructions
Discharge instruction summary for Upper GI Bleed (Peptic Ulcer Disease)
Diagnosis and what happened
You were treated for bleeding in the upper part of your digestive tract, most likely from a stomach or duodenal ulcer
An endoscopy (camera procedure) was performed to find and treat the source of bleeding
Medications to take
Take your prescribed acid-blocking medication (proton pump inhibitor) exactly as directed
Do not stop taking your PPI early even if you feel better
If prescribed H. pylori antibiotics, complete the full 14-day course
Medications to avoid
Do not take ibuprofen, naproxen, aspirin (unless specifically directed by your physician), or other anti-inflammatory medications
Do not take blood thinners unless your doctor specifically tells you to resume them
Avoid alcohol; it irritates the stomach lining and increases bleeding risk
Lifestyle and diet
Resume eating small, bland meals when you feel able, usually within 24 hours of discharge
Avoid spicy foods, caffeine, and carbonated drinks during recovery
Do not smoke; smoking slows ulcer healing and increases rebleeding risk
Stay well hydrated with water and non-caffeinated fluids
Follow-up appointments
Follow up with a gastroenterologist within 1–2 weeks of discharge
If you had a gastric (stomach) ulcer, a repeat endoscopy is recommended in 8–12 weeks to confirm healing and rule out cancer
H. pylori eradication should be confirmed with a breath test or stool test at least 4 weeks after finishing antibiotics
Return to emergency department immediately if you experience
Vomiting blood or coffee-ground material
Black, tarry, or bloody stools
Dizziness, lightheadedness, or fainting
Severe stomach pain or sudden worsening abdominal pain
Chest pain or shortness of breath
Weakness or feeling significantly worse
References
Guidelines and key sources
Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. The American Journal of Gastroenterology. 2021. https://doi.org/10.14309/ajg.0000000000001245
Primary guideline informing management of UGIB and PUD bleeding
Gralnek IM, Morris J, Laursen SB, et al. Endoscopic Diagnosis and Management of Peptic Ulcer Bleeding: ESGE Guideline Update 2026. Endoscopy. 2026. https://pubmed.ncbi.nlm.nih.gov/42127996
Current European endoscopy guideline; OTSC and combination therapy recommendations
Laine L. Upper Gastrointestinal Bleeding Due to a Peptic Ulcer. N Engl J Med. 2016. https://www.nejm.org/doi/full/10.1056/NEJMcp1514257
Comprehensive clinical review; antithrombotic resumption RCT data
Lau JYW, Yu Y, Tang RSY, et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N Engl J Med. 2020. https://www.nejm.org/doi/full/10.1056/NEJMoa1912484
RCT demonstrating no benefit of urgent vs. early endoscopy
Almadi MA, Lu Y, Alali AA, Barkun AN. Peptic Ulcer Disease. Lancet. 2024. https://pubmed.ncbi.nlm.nih.gov/38885678
Contemporary PUD epidemiology, pathophysiology, and management review
Vakil N. Peptic Ulcer Disease: A Review. JAMA. 2024. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2024.19094
Scoring systems, risk factors, and H. pylori management overview
Stanley AJ, Laine L, Dalton HR, et al. Comparison of Risk Scoring Systems for UGIB: International Multicentre Prospective Study. BMJ. 2017. https://pubmed.ncbi.nlm.nih.gov/28053181
GBS vs. Rockall vs. AIMS65 comparative validation study
Abraham NS, Barkun AN, Sauer BG, et al. ACG-CAG Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute GI Bleeding. AJG. 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966740/
Antithrombotic resumption guidance post-UGIB
Zetner D, Roost I, Rosenberg J, Andresen K. Prophylactic Transarterial Embolization in Patients With Bleeding Peptic Ulcers Following Endoscopic Control. Cochrane Database. 2025. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014999.pub2/full
Systematic review: prophylactic TAE not superior to standard care
Nagpal P, Dane B, Aghayev A, et al. ACR Appropriateness Criteria: Nonvariceal Upper Gastrointestinal Bleeding: 2024 Update. J Am Coll Radiol. 2024. https://doi.org/10.1016/j.jacr.2024.08.021
Imaging algorithm and CTA appropriateness criteria
Tarasconi A, Coccolini F, Biffl WL, et al. Perforated and Bleeding Peptic Ulcer: WSES Guidelines. World J Emerg Surg. 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947898/
Surgical management and escalation guidance
Long B, Gottlieb M. Emergency Medicine Updates: Upper Gastrointestinal Bleeding. Am J Emerg Med. 2024. https://pubmed.ncbi.nlm.nih.gov/38723362
Emergency medicine-focused clinical update and pearls
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.