So what if NICE say:

1.4.3 Do not offer acid-suppression drugs (proton pump inhibitors or H₂-receptor antagonists) before endoscopy to patients with suspected non-variceal upper gastrointestinal bleeding.

What do they know?

To be honest, you’ve seen PPIs given several times by your seniors. And it probably isn’t wrong per se, but rather it’s not the priority of management. The abdo xray was a waste of time though – abdo xrays are literally for ? obstruction and ? toxic megacolon and not much else.

Then the patient dies.

The patient basically needed a cross match and spot Hb to be stabilised prior to endoscopy.