Management of Nonvariceal Upper Gastrointestinal Bleeding
Publication Date: December 1, 2019
Last Updated: March 14, 2022
Consensus Recommendations
Resuscitation, risk assessment, and preendoscopy management
For patients with acute upper gastrointestinal bleeding (UGIB) and hemodynamic instability, resuscitation should be initiated.
(good practice statement)
612
For patients with acute UGIB, we suggest using a Glasgow Blatchford score of ≤1 to identify patients who are at very low risk for rebleeding or mortality and thus may not require hospitalization or inpatient endoscopy.
612
For patients with acute UGIB, we suggest against using the AIMS65 prognostic score to identify patients who are at very low risk for rebleeding or mortality and thus may not require hospitalization or inpatient endoscopy.
612
Consider placement of a nasogastric tube in selected patients because the findings may have prognostic value.
612
In patients with acute UGIB without underlying cardiovascular disease, we suggest giving blood transfusions for those with a hemoglobin level <80 g/L.
612
In patients with acute UGIB with underlying cardiovascular disease, we suggest giving blood transfusions at a higher hemoglobin threshold than for those without cardiovascular disease.
612
In patients with acute UGIB receiving anticoagulants (vitamin K antagonists, direct oral anticoagulants [DOACs]), we suggest not delaying endoscopy (with or without endoscopic hemostatic therapy).
612
Promotility agents should not be used routinely before endoscopy to increase the diagnostic yield.
612
Selected patients with acute ulcer bleeding who are at low risk for rebleeding on the basis of clinical and endoscopic criteria may be discharged promptly after endoscopy.
612
Pre-endoscopic proton-pump inhibitor (PPI) therapy may be considered to downstage the endoscopic lesion and decrease the need for endoscopic intervention but should not delay endoscopy.
(No recommendation)612
Overview
Title
Management of Nonvariceal Upper Gastrointestinal Bleeding
Authoring Organization
Consensus and Physician Experts