Discussion
Benefits from Early Administration of iv PPI
Using probabilities from the literature and a decision analysis model, we found that early administration of iv PPI to all subjects presenting to the ED
with signs of acute UGI bleeding results in a reduction of overall costs. Additionally, the iv PPI
strategy yielded better outcomes than standard
treatment.
The therapeutic and management advantages of
early administration of iv PPI are potentially threefold. First, raising intragastric pH before endoscopic treatment may contribute to promoting a
sustained resolution of the bleed through clot preservation [43,44]. Second, a formal diagnosis of
bleeding peptic ulcer via endoscopy is frequently
made well into the first 24 hours after admission [8–
10] delaying treatment for subjects who could benefit immediately from iv PPI therapy. Third, this
treatment protocol is simple to implement, requires
few resources, and can be easily restricted to a
patient population with poorer prognostic factors,
i.e., hypotension, low hemoglobin, and comorbid
disease [45].