Upper gastrointestinal bleeding

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:

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