Intravenous infusion of erythromycin before endoscopy in patients with nonvariceal upper gastrointestinal bleeding should be considered to improve diagnostic yield, and decrease the need for repeat endoscopy.
The National Institute for Health and Care Excellence (NICE) in the UK recommends that all patients with acute upper gastrointestinal bleeding should be risk-assessed using the Glasgow-Blatchford bleeding score (GBS) at first assessment and the full Rockall score after endoscopy.
Three additional new or updated guidelines (from the European Society of Gastrointestinal Endoscopy, the Japan Gastroenterological Endoscopy Society, and the Chinese Society of Digestive Endoscopy) offer further region-specific advice on selecting and using a scoring system for stratifying patients.   
The European Society of Gastrointestinal Endoscopy does not recommend the routine use of nasogastric or orogastric aspiration/lavage in patients presenting with acute upper gastrointestinal haemorrhage.See Diagnosis: approach
Upper gastrointestinal bleeding (UGIB) refers to GI blood loss whose origin is proximal to the ligament of Treitz at the duodenojejunal junction. Acute UGIB can manifest in a variety of manners, including haematemesis, coffee-ground emesis, the return of bright red blood through a nasogastric tube, and melaena with or without haemodynamic compromise. Haematochezia (bright red blood per rectum) may rarely occur in patients with an extremely brisk UGIB.   Causes are multiple, but in westernised countries they are usually secondary to either varices or peptic ulcer disease (PUD).
UGIB results in more than 300,000 hospital admissions annually in the US, with a mortality of 7% to 10%.  The annual incidence in the UK is 50 to 150 per 100,000, with the highest incidence in socio-economically deprived areas.  Ordinarily, mortality is secondary to hypovolaemic shock. Rapid evaluation, haemodynamic resuscitation, and appropriate pharmacological and endoscopic interventions are the cornerstones of therapy.
Professor of Medicine
Division of Gastroenterology
Department of Internal Medicine
Huntsman Cancer Institute
University of Utah
Salt Lake City
DGA has consulted for BSC and Merit, who make endoscopic retrograde cholangio-pancreatography (ERCP) products. He is also an author of references cited in this topic.
Dr Douglas G. Adler would like to gratefully acknowledge the assistance of Dr Patrick D. Martin. PDM declares that he has no competing interests.
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
NS declares that he has no competing interests.
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
DJH declares that he has no competing interests.
Divisione di Gastroenterologia
Ospedale V. Cervello
GM declares that he has no competing interests.
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