Pre‐endoscopic PPI therapy reduces recurrent adverse outcomes in acute non‐variceal upper gastrointestinal bleeding: authors' reply

Abstract

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.