Table 2.
Areas requiring further investigation
Pharmacologic therapy prior to endoscopy | Determine optimal route and dosage of PPI in UGIH (continuous infusion vs intermittent IV bolus vs oral dosing) |
Timing of endoscopic evaluation | Defining optimal timing of initial endoscopy, implementation of early discharge in low risk patients |
Prokinetic agents as endoscopic adjuncts | Clearly define the role for prokinetics in UGIH with randomized controlled trials, specifically define the optimal agent, dose and timing prior to endoscopy |
Long-term PPI management | Clarification of potential long-term sequelae of PPI including: osteoporosis, c. difficile infection and community-acquired pneumonia |
PPI and thienopyridines | Consensus on the clinical importance of this interaction, a complete randomized controlled trial to support the truncated COGENT trial data |
H. pylori and UGIH | H. pylori testing that allows accurate test results in the setting of acute UGIH |
PPI: Proton pump inhibitor; H. pylori: Helicobacter pylori; UGIH: Upper gastrointestinal tract hemorrhage; IV: Intravenous; COGENT: Clopidogrel and the optimization of gastrointestinal events trial.