Q: Why Continuous Proton Pump Inhibitor (PPI) drip is recommended in active GI bleed?

Answer:   Sustained high PH is required to promote clot stabilization in bleeding GI ulcers. Continuous PPI infusion (infusion at 8 mg/h) reliably achieves high target PH, usually preceded by an 80 mg bolus IV push. Target PH goal is more than 6.

PPIs only inhibit stimulated parietal cells with active proton pumps and this is most successfully and rapidly achieved by administering a bolus dose intravenously; continuous infusion then provides a steady state of the drug to inactivate any newly synthesized proton pumps, as well as any newly recruited proton pumps on parietal cells, which continue to be stimulated by gastrin, histamine and food.