Upper GI Bleeding — ESEGH MCQ
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Correct answer: C — Intravenous erythromycin to promote gastric emptying
Erythromycin (250 mg IV given 30 minutes pre-endoscopy) acts as a prokinetic agent enhancing gastric motility and promoting gastric emptying, thereby improving mucosal visibility during endoscopy in the presence of blood and clot. This directly addresses the stem's requirement to improve visualization. Option B (high-dose PPI) is explicitly not recommended pre-endoscopy by NICE and BSG guidelines, as PPIs reduce stigmata of recent haemorrhage and may obscure endoscopic targets without improving clinical outcomes. Option D (octreotide) is indicated only in suspected variceal bleeding, not universally. Option E is incorrect because colonoscopy evaluates the colon, not the upper GI tract. Option A ignores evidence-based pre-endoscopic optimization of visualization.
Reference: British Society of Gastroenterology (2024). Pharmacological management of acute upper gastrointestinal bleeding. https://www.bsg.org.uk/web-education/pharmacological-management-of-augib; NICE CG141 (2012). Management of acute upper gastrointestinal bleeding.