Upper gastrointestinal bleeding can be manifest as:
- haematemesis - the vomiting of frank blood
- melaena - the passing of altered blood per rectum
Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. Despite changes in management, mortality has not significantly improved over the past 50 years.
- elderly patients and people with chronic medical diseases withstand acute upper gastrointestinal bleeding less well than younger, fitter patients, and have a higher risk of death
- almost all people who develop acute upper gastrointestinal bleeding are treated in hospital
- most common causes are peptic ulcer and oesophagogastric varices
- endoscopy is the primary diagnostic investigation in patients with acute upper gastrointestinal bleeding
Drugs may have a complementary role in reducing gastric acid secretion and portal vein pressure. Not every patient responds to endoscopic and drug treatments; emergency surgery and a range of radiological procedures may be needed to control bleeding.
Risk assessment
- 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
- offer endoscopy to unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation
- offer endoscopy within 24 hours of admission to all other patients with upper gastrointestinal bleeding
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