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KEITH M. OLSEN, PHARM.D., FCCP, FCCM, is Professor of Pharmacy, University of Nebraska Medical Center, 980645 Nebraska Medical Center, Omaha, NE 68198-6045 (kolsen{at}unmc.edu).

Purpose. Prognostic factors in patients with peptic ulcer bleeding and therapeutic strategies for preventing the recurrence of bleeding are described. Summary. The risk of complications and death in a patient with acute upper gastrointestinal bleeding can be predicted based on certain clinical factors, the most important being the endoscopic findings. Proton pump inhibitors (PPIs) are the drugs of choice for patients with peptic ulcer bleeding because the drugs are more effective than histamine H2-receptor antagonists for maintaining the target intragastric pH (6 or higher) and preventing the recurrence of peptic ulcer bleeding, although an impact on mortality has not been demonstrated. High-dose intravenous PPI therapy should be used for patients at high risk of rebleeding (based on endoscopic findings). Oral PPI therapy may be used for low-risk patients. Underlying causes of ulcers should also be addressed and treated as necessary. Conclusion. Acid-suppression therapy using PPIs is effective for reducing the risk for recurrence of peptic ulcer bleeding. Index terms: Dosage; Drug administration routes; Gastrointestinal drugs; Gastrointestinal hemorrhage; Mortality; Ulcers