76-year-old lady had a GI bleed 10 months ago related to NSAID use - TopicsExpress

76-year-old lady had a GI bleed 10 months ago related to NSAID use for osteoarthritis. At that time an endoscopy showed a Duodenal Ulcer which was treated. She now re-presents with an acute haematemesis following represcription of diclofenac with misoprostol. Her Hb on admission is 5.6 g/dL. OGD is performed, showing a single bleeding vessel on the posterior wall of the duodenum. Injection sclerotherapy is attempted but fails to stop the bleeding. What is the next step in her management? a) IV omeprazole b) Octreotide c) Repeat attempt at sclerotherapy the following day d) Urgent referral to on-call surgeons

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