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Peptic Ulcer Bleeding — RACP Adult Medicine MCQ

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ModerateGastroenterologyPeptic Ulcer BleedingRACP Adult Medicine

A 72-year-old man on aspirin and clopidogrel presents with melaena. Upper endoscopy reveals a 15 mm duodenal ulcer with a visible vessel in the base (Forrest IIa). What is the most appropriate endoscopic management?

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Correct answer: D — Proton pump inhibitor infusion

A Forrest IIa ulcer (visible vessel without active bleeding) is a high-risk lesion requiring endoscopic haemostasis (combination of adrenaline injection and thermal coagulation or clips) followed by high-dose IV PPI infusion (e.g., pantoprazole 80 mg bolus then 8 mg/hr for 72 hours). The PPI reduces rebleeding rates. The option best matching the post-endoscopic medical therapy is PPI infusion.

Reference: eTG Gastrointestinal – 2024 – Upper GI Bleeding