Acute upper gastrointestinal bleeding in over 16s: management

Introduction

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 and the guideline therefore focuses on hospital care. The most common causes are peptic ulcer and oesophago-gastric varices.

Endoscopy is the primary diagnostic investigation in patients with acute upper gastrointestinal bleeding but it has not always been clear whether urgent endoscopy is cost effective as well as clinically valuable. Endoscopy aids diagnosis, yields information that helps predict outcome and most importantly allows treatments to be delivered that can stop bleeding and reduce the risk of re-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.

This guideline aims to identify which diagnostic and therapeutic steps are useful in managing acute upper gastrointestinal bleeding. This should enable hospitals to develop a structure in which clinical teams can deliver an optimum service for people who develop this condition.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.