For clinically high-risk ANVUGIB patients, performing endoscopy within 6 h of presentation is no more effective than performing endoscopy between 6 h and 24 h after presentation. The role of RE in high-risk ANVUGIB patients requires further delineation in a prospective fashion.

SUMMARY BackgroundProton pump inhibitors (PPIs) following endoscopic haemostasis reduce rebleeding rates in patients with high-risk acute non-variceal upper gastrointestinal bleeding. Many advocate the use of PPIs prior to endoscopy, although its incremental benefit is unproven.

Intravenous proton pump inhibitors (IV PPIs) decrease rebleeding following endoscopic hemostasis of bleeding peptic ulcers. Oral PPIs may be equally efficacious and may significantly reduce health care costs. This study aimed to compare outcomes in patients receiving oral versus IV PPI therapy following endoscopic hemostasis in patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB). We performed a retrospective review of all patients who received PPI therapy following endoscopic hemostasis for ANVUGIB. The primary outcome was the adverse gastrointestinal event rate. One hundred sixty-two patients met the entry criteria (72 oral PPIs, 90 IV PPIs). The difference in the rate of adverse gastrointestinal events between the two groups was 1% (P = 0.85). Postendoscopic IV PPI use was associated with an odds ratio of 1.01 for developing an adverse outcome versus oral PPIs (95% CI: 0.44-2.33). We conclude that oral PPIs are probably equivalent to IV PPIs for preventing rebleeding in ANVUGIB patients.

and a member of the first-year engineering team. The focus of this team is on providing a consistent, comprehensive, and constructive educational experience that endorses the student-centered, professional and practiceoriented mission of Northeastern University. She teaches the Cornerstone of Engineering courses to firstyear students as well as courses within the Civil and Environmental Engineering Department. She is a recent recipient of the Outstanding Teacher of First-Year Students Award and is interested in research that compliments and informs her teaching.

modalities had different re-bleeding rates. 7, 8 For example, placement of a hemoclip has a lower re-bleeding rate than those of other methods. 9, 10 Therefore, a prospective, randomized-controlled study with one therapeutic modality is needed in the future.Pre-endoscopic PPI therapy reduces recurrent adverse outcomes in acute non-variceal upper gastrointestinal bleeding: authors' reply SIRS, Thank you for the insightful comments regarding our manuscript. We would like to address some of the concerns raised by Dr Lin.First, he comments that there is a much higher incidence of high-risk stigmata in the group who received pre-endoscopic proton pump inhibitor (PPI) therapy. We think he may have misinterpreted the table, as the numbers given are not absolute numbers, but instead are proportions (i.e. not 44/132 but 44% out of a total number of 132). Also, as patients may have had multiple lesions and multiple stigmata (i.e. both a non-bleeding visible vessel and oozing from another site) the proportions are not purely additive. In our study, there was a trend towards a decrease in the risk of having high-risk stigmata with preendoscopic PPI therapy (47% vs. 57%, P ¼ 0.085), with high-risk stigmata defined as active arterial bleeding, non-bleeding visible vessel, adherent clot or oozing. This finding suggests that pre-endoscopic PPI therapy may assist in stabilizing clots and improving ulcer healing, leading to increased down-grading of high-risk stigmata.