PPI Therapy Does Not Reduce Prevalence of HRS or Decrease Need for Subsequent Endoscopy in Patients With UGIB

Investigators assessed the outcomes of patients with peptic ulcer and non-ulcer lesions who did or did not receive pre-endoscopic proton pump inhibitor therapy.

Proton pump inhibitor (PPI) therapy administered prior to endoscopy was not found to significantly decrease the prevalence of high-risk stigmata (HRS) or the need for endoscopic treatment in patients with non-variceal upper gastrointestinal bleeding (UGIB) and either peptic ulcer or non-ulcer lesions, according to study data published in Digestive and Liver Disease.

UGIB is a common emergency in clinical practice, and the majority of these cases are non-variceal and caused by gastroduodenal peptic ulcers. Some guidelines for the management of upper non-variceal bleeding suggest the use of pre-endoscopic, high-dose PPI as a cornerstone therapy to reduce the rate of peptic ulcers with HRS requiring endoscopic treatment. However, this practice has been questioned, due partly to insufficient data on the role of PPI therapy prior to endoscopy on bleeding lesions other than peptic ulcers.

In this study, the researchers evaluated the prevalence of HRS on peptic ulcer and non-ulcer lesions in patients either receiving (n=1792) or not receiving (n=774) pre-endoscopic PPI therapy. They found that the prevalence of HRS on ulcers was 51.8% and 53.4% (P =.58) in treated and not treated patients, respectively, and that the rate of endoscopic therapy did not differ between groups.

Notably, the prevalence of non-ulcer bleeding lesions was higher in patients treated with PPI therapy than in those not treated with PPI therapy (18.7% vs 10.6%; P =.023). In a multivariate analysis, PPI therapy (odds ratio [OR], 1.16; 95% CI, 0.82-1.64; P =.4) was not found to be an independent factor affecting HRS prevalence, which was inversely correlated with timing to endoscopy (OR, 0.85; 95% CI, 0.76-0.95; P =.005).

“In conclusion, our large study failed to detect a significant role of pre-endoscopic, high-dose PPI therapy in decreasing the prevalence of HRS and the need for endoscopic treatment in bleeding patients with either peptic ulcer or non-ulcer lesions managed in a setting where upper endoscopy is performed as soon as possible,” the study authors concluded. “Further – and possibly randomised – studies are needed in a similar setting to confirm our findings,” they added.


Marmo R, Soncini M, Bucci C, Zullo A; Gruppo Italiano per lo Studio dell’Emorragia Digestiva (GISED). Pre-endoscopic intravenous proton pump inhibitors therapy for upper gastrointestinal bleeding: A prospective, multicentre study. Dig Liver Dis. Published online November 05, 2020. doi:10.1016/j.dld.2020.10.023