Upper Gastrointestinal Haemorrhage

Author: Janet Skinner / Editors: Alasdair Gray, Tadgh Moriarty, Chris Gray / Reviewer: Chris Gray / Code: A3 / Published: 28/06/2021 / Reviewed: 15/08/2025

This session covers the assessment and management of upper gastrointestinal (GI) haemorrhage.

By the end of this session you will be able to:

  • Evaluate a patient and identify the likely underlying reason for an upper gastrointestinal (GI) haemorrhage
  • Describe appropriate resuscitative measures in patients who have suffered a moderate to severe GI haemorrhage
  • Demonstrate a rational approach to medical therapy in patients with an upper GI haemorrhage
  • Apply appropriate risk assessment tools to identify high and low risk patients with an upper GI haemorrhage
  • Identify patients who would benefit from early referral to a critical care area and consideration of urgent endoscopy

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References

  1. Acute upper gastrointestinal bleeding in over 16s: management. CG141. Updated August 2016
  2. Henneman PL. Gastrointestinal Bleeding. In Rosens Emergency Medicine, 5th 2002 Edition, Mosby, London, pg 195
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  4. Laine L, Laursen SB, Zakko L, et al., Severity and Outcomes of Upper Gastrointestinal Bleeding With Bloody Vs. Coffee-Grounds Hematemesis. Am J Gastroenterol. 2018 Mar;113(3):358-366.
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  9. Siau K, Hearnshaw S, Stanley AJ, et al. British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding. Frontline Gastroenterol. 2020 Mar 27;11(4):311-323.
  10. Rockall TA, Logan RFA, Devlin HB, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;38(3):316-21
  11. Sreedharan A, et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database of Systematic Reviews 2010, Issue 7
  12. Kanno T, Yuan Y, Tse F, et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2022 Jan 7;1(1):CD005415.
  13. Roberts I, Shakur-Still H, Afolabi A, et al., Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. The Lancet. 2020; 395(10241):1927-1936.
  14. Tripathi D, Stanley AJ, Hayes PC, et al. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015 Nov;64(11):1680-704.
  15. Chavez-Tapia NC, Barrientos-Gutierrez T, et al. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010 Sep 8;2010(9):CD002907.
  16. Palmer K. Non-variceal upper gastrointestinal haemorrhage: Guidelines. Gut 2002;51:1-6.
  17. Ramaswamy RS, Choi HW, et al. Role of interventional radiology in the management of acute gastrointestinal bleeding. World J Radiol. 2014 Apr 28;6(4):82-92.

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