Last reviewed: November 2017
Last updated: November  2017

Important updates

Intravenous infusion of erythromycin before endoscopy in patients with nonvariceal upper gastrointestinal bleeding

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.

Original source of update

Updated NICE guideline covering use of risk assessment tools for patients presenting to the emergency department with upper gastrointestinal bleeding

  • 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. [8] [9] [10]

Original source of update

Gastric lavage in patients presenting with acute upper gastrointestinal haemorrhage

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

Original source of update

Summary

Differentials

Common

  • Peptic ulcer disease (PUD)
  • Oesophageal varices
  • Oesophagitis
  • Mallory-Weiss tear

Uncommon

  • Boerhaave syndrome (spontaneous oesophageal perforation)
  • Gastric varices
  • Arteriovenous malformations (AVMs)
  • Dieulafoy's lesions
  • Upper GI tumours
  • Aortoenteric fistulae (AEF)
  • Coagulopathy

Contributors

Authors VIEW ALL

Professor of Medicine

Division of Gastroenterology

Department of Internal Medicine

Huntsman Cancer Institute

University of Utah

Salt Lake City

UT

Disclosures

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.

Peer reviewers VIEW ALL

Professor of Medicine

Chief of Clinical Gastroenterology and Hepatology

University of Texas Medical Branch

Galveston

TX

Disclosures

NS declares that he has no competing interests.

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

Consultant Gastroenterologist

Divisione di Gastroenterologia

Ospedale V. Cervello

Palermo

Italy

Disclosures

GM declares that he has no competing interests.

Use of this content is subject to our disclaimer