Q: 65 year old male on warfarin for atrial fibrillation, presented to ER with severe upper GI bleed. GI service would be available to perform upper scope in 2 hours. All of the following are part of this severe acute upper non-variceal GI bleed except?

A) pRBC

B) FFP

C) IV Proton pump inhibitor

D) Erythromycin

E) Octrotide

Answer: E

A, B and C are obvious choices. Objective of this question is 2 folds.

Firstly, to limelight role of prokinetics in patients with acute upper GI bleeding. Prokinetic agent improves gastric visualization at the time of endoscopy by clearing the stomach of clots, and food. In severe upper GI bleed erythromycin with dose of 3 mg/kg IV over 30 minutes, an hour prior to endoscopy may help. Studies have found it to be a very safe strategy.

Secondly, to emphasize that Octreotide is not recommended for routine use in patients with acute nonvariceal upper GI bleeding, though it is used as a precaution when endoscopy is not quickly available or not possible for other reasons.