This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages without signing in

Acute management of gastrointestinal haemorrhage

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Seek expert advice and consult local guidelines.

Risk assessment

  • following formal risk assessment scores should be used for all patients with acute upper gastrointestinal bleeding:
    • the Blatchford score at first assessment,
    • and the full Rockall score after endoscopy
  • if a pre-endoscopy Blatchford score of 0 then consider early discharge

Timing of endoscopy

  • unstable patients with severe acute upper gastrointestinal bleeding should be offered an endoscopy immediately after resuscitation
  • all other patients with upper gastrointestinal bleeding should be offered an endoscopy within 24 hours of admission

Resuscitation and initial management

  • transfuse patients with massive bleeding with blood, platelets and clotting factors in line with local protocols for managing massive bleeding
    • base decisions on blood transfusion on the full clinical picture, recognising that over-transfusion may be as damaging as under-transfusion

  • do not offer platelet transfusion to patients who are not actively bleeding and are haemodynamically stable

  • offer platelet transfusion to patients who are actively bleeding and have a platelet count of less than 50 x 10^9/litre

  • offer fresh frozen plasma to patients who are actively bleeding and have a prothrombin time (or international normalised ratio) or activated partial thromboplastin time greater than 1.5 times normal
    • if a patient's fibrinogen level remains less than 1.5 g/litre despite fresh frozen plasma use, offer cryoprecipitate as well

  • offer prothrombin complex concentrate to patients who are taking warfarin and actively bleeding

  • treat patients who are taking warfarin and whose upper gastrointestinal bleeding has stopped in line with local warfarin protocols

  • do not use recombinant factor Vlla except when all other methods have failed



Proton pump inhibitors

  • do not offer acid-suppression drugs (proton pump inhibitors or H2-receptor antagonists) before endoscopy to patients with suspected non-variceal upper gastrointestinal bleeding
  • offer proton pump inhibitors to patients with non-variceal upper gastrointestinal bleeding and stigmata of recent haemorrhage shown at endoscopy

Management of non-variceal bleeding

  • adrenaline should not be used as monotherapy for the endoscopic treatment of non-variceal upper gastrointestinal bleeding
  • for the endoscopic treatment of non-variceal upper gastrointestinal bleeding, use one of the following:
    • a mechanical method (for example, clips) with or without adrenaline
    • thermal coagulation with adrenaline fibrin or
    • thrombin with adrenaline
  • interventional radiology should be offered to unstable patients who re-bleed after endoscopic treatment
  • refer urgently for surgery if interventional radiology is not promptly available

Management of variceal bleeding

  • terlipressin should be offered to patients with suspected variceal bleeding at presentation. Stop treatment after definitive haemostasis has been achieved, or after 5 days, unless there is another indication for its use
  • prophylactic antibiotic therapy should be offered at presentation to patients with suspected or confirmed variceal bleeding
  • oesophageal varices
    • use band ligation in patients with upper gastrointestinal bleeding from oesophageal varices
    • consider transjugular intrahepatic portosystemic shunts (TIPS) if bleeding from oesophageal varices is not controlled by band ligation.
  • gastric varices
    • endoscopic injection of N-butyl-2-cyanoacrylate should be offered to patients with upper gastrointestinal bleeding from gastric varices
    • TIPS should be offered if bleeding from gastric varices is not controlled by endoscopic injection of N-butyl-2-cyanoacrylate

Reference:

  1. NICE (August 2016). Acute Upper GI bleeding.

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.