upper GI bleeding

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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

Reference:

Last reviewed 01/2018

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