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Upper GI Bleeding — ESEGH MCQ

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ModerateGastroenterologyUpper GI BleedingESEGH

A 54‑year‑old patient presents with upper gastrointestinal bleeding from a duodenal ulcer. Successful endoscopic hemostasis is achieved. Which immediate post‑endoscopy acid‑suppressive regimen is recommended?

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Correct answer: B — High‑dose PPI (continuous or intermittent IV infusion for 72 hours, or high‑dose oral BID), followed by standard‑dose oral PPI for up to 2 weeks

European Society of Gastrointestinal Endoscopy (ESGE) guidelines—used in UK specialty practice—strongly recommend initiating high‑dose PPI post successful endoscopic hemostasis for peptic ulcer bleeding. The regimen comprises an 80 mg IV bolus followed by continuous infusion at 8 mg/hour for 72 hours, or alternatively high‑dose intermittent IV or oral BID dosing, then transition to standard oral PPI. This maintains intragastric pH > 6, stabilizes clot, and reduces re‑bleeding risk. Standard‑dose once‑daily PPI (option A) does not provide sufficient acid suppression in this acute phase; H2‑blockers (option C) are inferior; omitting therapy (option D) risks re‑bleeding; sucralfate (option E) lacks evidence in this context.

Reference: ESGE Guideline: Endoscopic diagnosis and management of non‑variceal upper GI hemorrhage, post‑endoscopy PPI recommendation, 2026; and ESGE 2021 update