Potassium-competitive Acid Blocker Versus Double Dose Proton Pump Inhibitors in High High-risk Peptic Ulcer Bleeding

Upper gastrointestinal bleeding is a common clinical condition associated with asubstantial risk of mortality, with ulcer bleeding accounting for the majority of cases.Current standard treatment consists of pharmacological therapy combined with endoscopichemostasis. Pharmacological therapy suppresses gastric acid secretion, reduces clotdissolution, and creates an environment conducive to mucosal healing.Various scoring systems are used clinically to assess disease severity and prognosis inpatients with ulcer bleeding. The Rockall score is one of the most commonly used systems.Patients with a Rockall score of 6 or higher have a higher risk of rebleeding andmortality. Therefore, high‐risk patients are generally treated with twice‐daily oralproton pump inhibitors (PPIs). However, twice‐daily dosing may reduce medicationadherence.Potassium‐competitive acid blockers (P‐CABs) have emerged in recent years and offerseveral potential advantages, including rapid onset of action, potent acid suppression,stability in an acidic environment, and a long half‐life. They may represent a newtreatment option for peptic‐ulcer disease. This study will therefore compare the efficacyof PPI and P‐CAB therapy in preventing recurrent bleeding among patients with uppergastrointestinal ulcer bleeding and a Rockall score of 6 or higher.This randomized clinical trial will enroll patients at National Cheng Kung UniversityHospital who have upper gastrointestinal ulcer bleeding, have undergone endoscopichemostasis, and have a Rockall score of 6 or higher.A total of 108 patients will be enrolled and randomly assigned to two groups:Standard‐treatment group: 54 patients, Experimental group: 54 patients.Both groups will receive standard endoscopic hemostasis and 72 hours of intravenous PPItherapy. Thereafter, patients in the standard‐treatment group will receive double‐dosePPI therapy, whereas patients in the experimental group will receive a P‐CAB per day. Allpatients will be followed for 28 days to assess the occurrence of rebleeding.