Upper GI Bleed — ESEGH MCQ
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Correct answer: D — Continuous infusion and high-dose intermittent regimens are both guideline-supported
After endoscopic haemostasis for high-risk peptic ulcer bleeding, current UK and European guidelines support both continuous IV PPI infusion and high-dose intermittent IV regimens. A meta-analysis of 13 randomised trials demonstrated non-inferiority of intermittent therapy for rebleeding, mortality, urgent intervention and transfusion requirements. Both routes achieve adequate gastric pH suppression. H2-blockers (option C) are significantly inferior to PPIs in preventing rebleeding after successful endoscopic treatment. Oral PPI once daily (option D) is insufficient; high-dose intravenous therapy is standard immediately post-endoscopy. PPIs must never be stopped (option E); they are continued for 72 hours to prevent recurrent bleeding. Continuous infusion alone is no longer mandatory (option B).
Reference: Bucks Formulary (NHS), 2024, citing NICE and ESGE guidance with supporting meta-analysis; https://www.bucksformulary.nhs.uk/docs/Guideline_656FM.pdf; Leontiadis et al. JAMA 2013, systematic review supporting non-inferiority of intermittent regimens