After successful endoscopic haemostasis of a high-risk peptic ulcer, high-dose PPI for 72 hours reduces rebleeding. The classic regimen is an 80 mg bolus followed by an 8 mg/hour infusion. Intermittent high-dose boluses — for example 40 mg twice daily or more — have been shown in meta-analysis to be non-inferior, and are simpler when infusion bags or pumps are short. Oral high-dose PPI is a reasonable step-down after 72 hours.
- Give high-dose PPI for 72 hours after haemostasis of high-risk stigmata
- 80 mg bolus then 8 mg/h, or intermittent high-dose boluses
- Switch to oral twice-daily PPI after 72 hours
- Test and treat H. pylori
Why it matters
With premixed bags under recall, knowing that bolus dosing works as well avoids delays.
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