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Gastroenterology


Answer 5
  1. Administer IV erythromycin 250 mg and repeat endoscopy in 1 hour. The blood in this patient’s stomach is precluding endoscopic visualization. Erythromycin is a macrolide antibiotic with potent gastric promotility effects. One dose of IV erythromycin has been shown to promote gastric emptying,2 which can clear gastric contents including blood and improve endoscopic visualization in many patients. This therapy is inexpensive and can be performed quickly. Levofloxacin is a fluoroquinolone antibiotic and does not have promotility properties comparable with those of erythromycin. The patient is experiencing hematemesis and cannot wait 24 hours to repeat the examination. Inducing vomiting could lead to aspiration and should be avoided. Surgical evaluation should be deferred at this time but could be considered if IV erythromycin and the repeat endoscopic procedure are unsuccessful.2

    REFERENCES
    2. Coffin B, Pocard M, Panis Y, et al. Erythromycin improves the quality of EGD in patients with acute upper GI bleeding: a randomized controlled study. Gastrointest Endosc 2002;56:174–9.

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