Management of non-variceal upper gastrointestinal tract hemorrhage: Controversies and areas of uncertainty

Table 2 Areas requiring further investigation

Pharmacologic therapy prior to endoscopy	Determine optimal route and dosage of PPI in UGIH (continuous infusion vs intermittent IV bolus vs oral dosing)
Timing of endoscopic evaluation	Defining optimal timing of initial endoscopy, implementation of early discharge in low risk patients
Prokinetic agents as endoscopic adjuncts	Clearly define the role for prokinetics in UGIH with randomized controlled trials, specifically define the optimal agent, dose and timing prior to endoscopy
Long-term PPI management	Clarification of potential long-term sequelae of PPI including: osteoporosis, c. difficile infection and community-acquired pneumonia
PPI and thienopyridines	Consensus on the clinical importance of this interaction, a complete randomized controlled trial to support the truncated COGENT trial data
H. pylori and UGIH	H. pylori testing that allows accurate test results in the setting of acute UGIH

PPI: Proton pump inhibitor; H. pylori: Helicobacter pylori; UGIH: Upper gastrointestinal tract hemorrhage; IV: Intravenous; COGENT: Clopidogrel and the optimization of gastrointestinal events trial.