The most appropriate management is prompt discharge on oral proton pump inhibitor (PPI) therapy. In addition, NSAIDs should be discontinued. Upper endoscopy identified several small gastric ulcers as this patient's bleeding source. Patients with low-risk stigmata (a clean-based ulcer [rebleeding risk with medical therapy 3%-5%] or a nonprotuberant pigmented spot in an ulcer bed [rebleeding risk with medical therapy 5%-10%]) can be fed within 24 hours, should receive oral PPI therapy, and can undergo early hospital discharge. This patient's ulcers did not require endoscopic therapy and are at low risk for rebleeding, especially with the daily use of an oral PPI and discontinuation of NSAIDs. Other clinical predictors that justify prompt discharge are this patient's stable vital signs, stable hemoglobin level, and absence of serious comorbidities.

Several studies have demonstrated similar outcomes in patients with low-risk ulcers who were discharged on the first hospital day compared with those hospitalized for longer periods of time. There is no benefit to another day of hospitalization for observation.

With a low-risk ulcer, feeding can be initiated and PPI therapy can be promptly switched from continuous intravenous infusion to an oral formulation. An additional 24 hours of an intravenous PPI therapy is unnecessary and needlessly expensive.

More than 90% of uncomplicated NSAID-induced gastric ulcers will heal with standard-dose PPI therapy if NSAID therapy is discontinued. This patient could be considered for upper endoscopy in 2 to 3 months to document healing of his gastric ulcers if dyspeptic symptoms persist despite therapy, the initial endoscopy was not complete in evaluating the stomach, gastric biopsies were not obtained on initial endoscopy, or the appearance of the gastric ulcer was suspicious for malignancy. If NSAID therapy is reinitiated in the future, co-therapy with a PPI should be employed to prevent a recurrent peptic ulcer. Misoprostol at 800 µg total daily dosing is an alternative to PPI therapy, but gastrointestinal side effects at this dose may be limiting. Twice-daily H₂-blocker therapy offers some benefit, but protection is inferior to that of PPI therapy. There is no need to routinely perform second-look endoscopy during hospitalization for an acute peptic ulcer bleed. Indications for repeat endoscopy in the hospital setting would include concern for ongoing gastrointestinal bleeding or an incomplete endoscopic evaluation with concern for missing a bleeding source.