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Friday, April 1, 2022

PPIs for GI bleeds

First10EM - By Justin Morgenstern - March 30, 2022
“The clinical summary
Although there are still large gaps in this evidence base, I think the clinical conclusion is very clear: PPIs should not be given. Every RCT conducted to date has been negative. There is no indication of clinical benefit, and we should be concerned about the possibility of an increase in mortality. 
Given the (marginal) benefit in patients with known bleeding ulcers, if a patient had a recent endoscopy with known peptic ulcer disease, I will give a single IV bolus of PPI. Given that the largest studies excluded the most critically ill patients, it seems reasonable to run further RCTs focusing specifically on that population. However, without further studies, I think it is very clear that we should not be prescribing PPIs, given their potential for harm and absolute lack of proven benefit“