The topic of PPIs for upper GI bleeds was one of the first posts on First10EM. There is no new evidence, and the bottom line is the same (just don’t use them), so if you are a long time reader, you can probably skip this post. However, that post was rather messy, and needed some updates.

If you are still using PPIs, or know someone who is, this is the evidence summary for you.

The numbers in this review make it pretty clear we are not going to see a difference in transfusion or surgery.

Rebleeding is a somewhat more nebulous concept, with multiple definitions, and varying impact on patients.

There is a suggestion that larger studies might find a benefit in this area. (Which would make sense, as rebleeding is decreased when we give PPIs to patients after the diagnosis of a peptic ulcer is made.)

On the other hand, we have to be careful, because the best current summary has the point estimate for mortality being higher in the PPI group.

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