PPI vs H2 in UGIB — ESEGH MCQ

Correct answer: A — PPI therapy reduces rebleeding rates better than H2 blockers after endoscopic haemostasis

PPIs are superior to H2 receptor antagonists for preventing rebleeding after endoscopic haemostasis in peptic ulcer bleeding. UK national guidance (NICE CG141) recommends PPI therapy for patients with peptic ulcer bleeding and endoscopic evidence of recent haemorrhage. High-quality RCT evidence and meta-analyses consistently demonstrate that PPIs reduce rebleeding rates significantly more than H2RAs: rebleeding rates are approximately 8–9% with PPIs versus 14–15% with H2RAs. This superiority is attributed to the more potent and sustained acid suppression achieved by PPIs, which block the final step of acid secretion and do not develop tachyphylaxis unlike H2RAs. Distractor B reverses the evidence. C incorrectly suggests equivalence despite robust differences in efficacy. D contradicts evidence that post-endoscopy acid suppression is beneficial and necessary, especially in high-risk patients. E is incorrect: sucralfate is not standard and is inferior to PPIs for this indication.

Reference: NICE guideline CG141 (June 2012), updated and validated by converging meta-analyses (Leontiadis et al. 2007; Laine et al. 2009) and randomised controlled trials showing consistent PPI superiority over H2RA in reducing rebleeding after endoscopic haemostasis. https://www.nice.org.uk/guidance/cg141/chapter/1-guidance