A U T H O R S ’ C O N C L U S I O N S
Implications for practice
PPI therapy is already widely initiated before endoscopy in patients
with upper gastrointestinal bleeding. The present analysis
did not find significant improvement with PPI treatment for clinically
important outcomes including rebleeding, surgery or mortality.
The reduced rate of serious endoscopic stigmata of bleeding
found at endoscopy among patients given PPI therapy before endoscopy
and the reduced requirement for endoscopic haemostatic
treatment are of uncertain clinical significance.However, PPI therapy
may have a role if prompt endoscopy is not readily available.
Among such patients in whom PPI therapy is initiated before endoscopy,
therapy can obviously be discontinued if endoscopy finds
no evidence of bleeding or evidence of bleeding from an alternate
source (for example, oesophageal or gastric varices).