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High-dose proton-pump inhibitor (PPI) therapy lowers risk for rebleeding in patients who have bleeding peptic ulcers with high-risk stigmata (active bleeding or nonbleeding visible vessels; Cochrane Database Syst Rev 2006; 1:CD002094). In patients with low-risk stigmata (i.e., clean ulcer base, flat pigmented lesions), PPI therapy has no effect. In most of the world, high-dose PPI therapy after endoscopic therapy for high-risk ulcer lesions is the standard of care; however, the value of PPI therapy before endoscopy is less clear, because most patients will not exhibit high-risk lesions at the time of endoscopy. A recent meta-analysis suggested that pre-endoscopy PPI therapy could lower the prevalence of high-risk stigmata at index endoscopy…