GUIDELINE STATEMENTS

Document Overview

Design and created by Guideline Central in participation with the American College of Gastroenterology.

Upper Gastrointestinal and Ulcer Bleeding

American College of Gastroenterology

Publication Date: Apr 30, 2021

Page Last Updated: May 5, 2026

GRADE Strength of Recommendations and Implications

Grade	Quality of Evidence
High	We are very confident that the true effect lies close to the estimate of the effect.
Moderate	We are moderately confident that the true effect lies close to that of the estimate of the effect. There is a possibility that it is substantially different.
Low	Our confidence that the true effect lies close to that of the estimate of the effect is low. The true effect may be substantially different from the estimate of the effect.
Very low	We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
Evidence / Knowledge Gap	Available evidence insufficient to determine true effect.

Grade	Strength of Recommendation
Strong “AGA recommends...”	For the Patient	For the Clinician	For policy makers
Strong “AGA recommends...”	Most individuals in this situation would want the recommended course and only a small proportion would not.	Most individuals should receive the intervention. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.	The recommendation can be adapted as policy or performance measure in most situations.
Conditional (weak) “AGA suggests...”	The majority of individuals in this situation would want the suggested course, but many would not.	Different choices will be appropriate for individual patients consistent with his or her values and preferences. Use shared decision making. Decision aids may be useful in helping patients make decisions consistent with their individual risks, values, and preferences.	Policy making will require substantial debate and involvement of various stakeholders. Performance measures should assess whether decision making is appropriate.
No recommendation “AGA makes no recommendation...”		The confidence in the effect estimate is so low that any effect estimate is speculative at this time.

Document Overview

Document Title: Upper Gastrointestinal and Ulcer Bleeding

Authoring Society: American College of Gastroenterology

Document Publication Date: Apr 30, 2021

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: journals.lww.com/ajg/Fulltext/2021/05000/ACG_Clinical_Guideline__Upper_Gastrointestinal_and.14.aspx

Source Citation: Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917. doi: 10.14309/ajg.0000000000001245. Erratum in: Am J Gastroenterol. 2021 Nov 1;116(11):2309. PMID: 33929377.

Supplemental Implementation Resources

Podcast

Document Scope, Criteria, and Use Cases

Scope: Diagnosis, Management

Diseases/Conditions (MeSH)

D041742 - Upper Gastrointestinal Tract

D010438 - Peptic Ulcer Hemorrhage

D041742 - Upper Gastrointestinal Tract

D010438 - Peptic Ulcer Hemorrhage

Keywords: Clinical Guideline, Endoscopic therapy, Erythromycin infusion, Ulcer Bleeding, Upper Gastrointestinal, absolute ethanol injection, duodenum, endoscopy, proton pump inhibitor therapy, transcatheter embolization

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Emergency Care, Hospital

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 124

Literature Search End Date: Monday, September 30, 2019

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Upper Gastrointestinal and Ulcer Bleeding

GUIDELINE STATEMENTS

Risk stratification

Red blood cell transfusion

Pre-endoscopic medical therapy

Prokinetic therapy with erythromycin

PPI therapy

Endoscopy for UGIB

Timing of endoscopy

Need for endoscopic hemostatic therapy for ulcers with active bleeding or nonbleeding visible vessels

Need for endoscopic hemostatic therapy for ulcers with adherent clot

Choice of endoscopic hemostatic therapy for bleeding ulcers

Antisecretory therapy after endoscopic hemostatic therapy for bleeding ulcers

Recurrent ulcer bleeding after successful endoscopic hemostatic therapy

Failure of endoscopic hemostatic therapy for bleeding ulcer

GRADE Strength of Recommendations and Implications

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology