Designed and created by Guideline Central in participation with the American College of Gastroenterology
Upper Gastrointestinal and Ulcer Bleeding
Patient Guideline Summary
Publication Date: May 1, 2021
Last Updated: March 3, 2023
This patient summary means to summarize key recommendations from the American College of Gastroenterology (ACG) guideline for the upper gastrointestinal and ulcer bleeding.
- If you have upper gastrointestinal bleeding, your care team may consist of an emergency medicine doctor, gastroenterologist, surgeon, or other allied providers.
- Gastrointestinal disease is a disease affecting any part of the gastrointestinal (GI) tract from the mouth to the anus.
- Gastrointestinal (GI) bleeding is a common medical condition.
- There is an upper and lower GI tract, and bleeding can happen in either, but this summary focuses on Upper GI bleeding.
- Upper GI bleeding originates from the esophagus (the tube that connects the mouth and the stomach), stomach, or duodenum (the first part of the small intestine).
- We will use the abbreviation (UGIB) throughout this guide to refer to Upper GI bleeding. We will use overt UGIB to describe upper GI bleeding with visible blood.
- Ulcer bleeding is the most common cause of UGIB.
- Symptoms include vomiting of red blood or coffee-ground material, black, tarry stool, or red or maroon material per rectum.
- This patient summary focuses primarily on endoscopic therapies (treating the bleeding by inserting an instrument [endoscope] to visualize it and using a drug or a non-surgical technique to stop the bleeding) and post-endoscopic management for patients with visible UGIB bleeding.
Evaluation and Diagnosis
Evaluation and Diagnosis
- Overview of Risk Stratification
- The first step to getting your UGIB under control is an evaluation to determine your risk category.
- Your risk is based on the Glasgow-Blatchford score. Your hemoglobin levels, blood urea nitrogen, blood pressure, heart rate, and other co-occurring conditions that affect your risk score.
- Risk categories include very low clinical risk and not very-low clinical risk.
- If you are a very low risk (Glasgow-Blatchford score 0–1) and if there is no other reason for hospitalization, you will probably leave the hospital and be scheduled for a follow-up.
- If you have UGIB, you will possibly get a red blood cell transfusion (transfer of blood or blood element from one person to another person) if your hemoglobin is 7 g/dL or less.
- If you have UGIB, you will possibly receive an antibiotic like erythromycin 250 mg injected into your vein 30-90 minutes before the upper endoscopy (a procedure when the healthcare provider inserts an instrument with a camera at the end to look inside your body).
- If you have UGIB, you will possibly get upper endoscopy (inserting an instrument to see a part of the body) within 24 hours of presentation.
- If you have UGIB with actively bleeding blood vessels and also visible vessels that are not bleeding, you will probably get endoscopic therapy (treating the bleeding by inserting an instrument [endoscope] to visualize it and using a drug or a non-surgical technique to stop the bleeding).
- If you have a bleeding ulcer, there are several ways to stop the bleeding through an endoscope. Blood vessels can be closed off with heat, an electric current, a tiny metal clamp, or an injection of pure (100%) alcohol or other chemicals.
- If you have successful endoscopic hemostatic therapy (treatment to stop bleeding) for a bleeding ulcer, you may get high-dose proton pump inhibitor (PPI) therapy (drugs that reduce stomach acid) for a few days. The dose will then most likely be reduced as you leave the hospital.
- A couple of weeks after another endoscopy shows you are healing, the PPI may be stopped.
- If you start bleeding again, the choice of treatment could be repeat endoscopy, surgery, or transcatheter arterial embolization (a procedure that inserts a long, thin device into a blood vessel, threads it to the bleeding site, and places a plug in the bleeding vessel).
- GI: Gastrointestinal
- PPI: Proton Pump Inhibitor
- UGIB: Upper Gastrointestinal Bleeding
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.
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.