The Annals of Internal Medicine has featured international consensus recommendations on the management of patients with non-variceal upper gastrointestinal bleeding.

The following statements have been made with respect to pharmacological management:
• Histamine-2 receptor antagonists are not recommended for patients with acute ulcer bleeding.
• Somatostatin and octreotide are not routinely recommended for patients with acute ulcer bleeding.
• An intravenous bolus followed by continuous-infusion proton pump inhibitor (PPI) therapy should be used to decrease re-bleeding and mortality in patients with high-risk stigmata who have undergone successful endoscopic therapy.
• Patients should be discharged with a prescription for a single daily-dose oral PPI for a duration as dictated by the underlying aetiology.

The following statements have been made with respect to prescribing aspirin or NSAIDs post-discharge:
• In patients with previous ulcer bleeding who require an NSAID, it should be recognised that treatment with a traditional NSAID plus PPI or a COX-2 inhibitor alone is still associated with a clinically important risk for recurrent ulcer bleeding.
• In patients with previous ulcer bleeding who require an NSAID, the combination of a PPI and a COX-2 inhibitor is recommended to reduce the risk for recurrent bleeding from that of COX-2 inhibitors alone.
• In patients who receive low-dose aspirin and develop acute ulcer bleeding, aspirin therapy should be re-started as soon as the risk for cardiovascular complication is thought to outweigh the risk for bleeding.
• In patients with previous ulcer bleeding who require cardiovascular prophylaxis, it should be recognised that clopidogrel alone has a higher risk for re-bleeding than aspirin combined with a PPI.