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Bleed Identified, Infection Ruled Out: What Next?


Does this patient need IV PPI, pRBCs, or maybe TLC for now?

A previously healthy 45-year-old man presents with melena of several day’s duration. On review of symptoms, he reports fatigue and light-headedness while standing. Results of laboratory studies reveal a hemoglobin level of 8 g/dL. He undergoes upper endoscopy, which demonstrates a 6-mm clean based ulcer in the duodenum without stigmata of bleeding. Tissue biopsies are taken to rule out Helicobacter pylori.

Which of the following steps would you recommend next?

A. Start intravenous PPI and continue for 3 days, then transition to oral PPI
B. Repeat endoscopy in 2 months to assess for healing
C. Transfuse 1 unit of pRBCs if hemoglobin drops below 7 g/dL
D. Perform capsule endoscopy
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