{
  "abstract": "Introduction Proton Pump Inhibitors (PPIs) are the bedrock of post-endoscopic non-variceal GI bleed management. National guidelines advise 72-hour continuous infusion 1 2; applied widely across NHS Scotland trusts. Emerging evidence shows IV bolus PPI can be a non-inferior, cost-effective alternative.3 In December 2022, the NHS Fife GI bleed bundle was changed to bolus PPI. We aimed to assess non-inferiority of clinical GI bleed outcomes subsequently, with the 2022 UK Comparative Audit of AUGIB as comparator.4Methods Retrospective audit of all upper GI endoscopies for confirmed upper GI bleed was conducted over 12-months in a high-volume endoscopy centre (311 endoscopies, 284 patients). Clinical outcomes defined by the UK 2022 audit were collected using electronic record search and endoscopy reports, including mortality, rebleeding, transfusion ≥1 unit, and length of stay (LoS). Comparative analysis of outcomes to UK 2022 audit data was calculated as Absolute Risk (AR), Relative Risk (RR) and chi-square test, using Microsoft Excel. Pre-defined 3% non-inferiority margin was used as per seminal meta-analysis on bolus PPI in upper GI bleeding. 3Results NHS Fife bolus PPI protocol demonstrated non-inferiority across all clinical outcomes compared to UK audit benchmarks ( table 1).Conclusion This is the first analysis of bolus PPI for upper GI bleed management in NHS Scotland. Bolus PPI was demonstrated as non-inferior to UK audit standards across all key clinical outcomes, in line with emerging international evidence. Given its known profile as resource, time and cost efficient, the data denoting comparable clinical efficacy supports wider use of bolus PPI across NHS Scotland trusts.References NICE. Acute Upper GI Bleeding Final Scope. National Institute for Health and Clinical Excellence (CG141); 2010.Siau K, Hearnshaw S, Stanley AJ, et al. British Society of Gastroenterology-led multisociety consensus care bundle for early clinical management of AUGIB. Frontline Gastroenterology. 2020;11(4):311–23.Sachar H, Vaidya K, Laine L, et al. Intermittent vs continuous proton pump inhibitor therapy for high-risk bleeding ulcers. JAMA Intern Med. 2014;174(11):1755–62.Nigam A, Smith J, Patel R, et al. UK 2022 comparative audit of acute upper gastrointestinal bleeding and the use of blood. National Comparative Audit of Blood Transfusion; 2025.Abstract P284 Table 1OutcomeNHS FIFE (n=284)UK 2022 Audit (n=5141)AnalysisRebleed Rate4.6% (n=13)9.6% (n=414/4279)RR 0.48, upper bound 1-sided 95% CI 0.71, p=0.005AR -5.6%, upper bound 1-sided 95% CI: -3.10%)Mortality6.7% (n=19)8.8% (n=451)RR 0.76, upper bound 1-sided 95% CI: 1.17, p=0.22AR -2.08%, upper bound 1-sided 95% CI: +0.47%Transfusion ≥1 unit44.0% (n=125)49.8% (n=2561)RR 0.88, upper bound 1-sided 95% CI: 1.00, p=0.07AR -5.80%, upper bound 1-sided 95% CI: +0.05%LoS5 days5 daysIQR 3-12 vs IQR 3-10",
  "authors": [
    {
      "affiliations": [
        "NHS East Lancashire, Salford, United Kingdom"
      ],
      "name": "Asad Jafferbhoy"
    },
    {
      "affiliations": [
        "NHS Fife, Kirkcaldy, United Kingdom"
      ],
      "name": "Aye Moh Moh Paing"
    },
    {
      "affiliations": [
        "NHS Fife, Kirkcaldy, United Kingdom"
      ],
      "name": "Aye Pyae Tin Hla"
    },
    {
      "affiliations": [
        "NHS Fife, Kirkcaldy, United Kingdom"
      ],
      "name": "Hasnain Jafferbhoy"
    }
  ],
  "title": "P284 Bolus proton-pump inhibitors for post-endoscopic management of GI bleeding as a clinically effective alternative to infusion: an audit",
  "uid": "725842c5-47c7-5f51-9d6c-ccbaceb95574"
}