Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- haematemesis
Other diagnostic factors
- light-headedness/dizziness
- postural/orthostatic hypotension
- dysphagia
- odynophagia
- retrosternal, epigastric, or back pain
- melaena
- haematochezia
- shock
- signs of anaemia
Risk factors
- condition predisposing to retching, vomiting, and/or straining
- chronic cough
- hiatal hernia
- endoscopy or other instrumentation
- heavy alcohol use
- age 30 to 50 years
- male sex
- hiccups
- blunt abdominal trauma
- cardiopulmonary resuscitation
Diagnostic investigations
1st investigations to order
- gastroscopy
- full blood count
- urea and creatinine
- liver function tests
- cross-matching/blood grouping
Investigations to consider
- prothrombin time/international normalized ratio (PT/INR)
- activated partial thromboplastin time (PTT)
- chest x-ray
- abdominal CT
- CT angiogram
Treatment algorithm
active non-variceal bleeding
Contributors
Expert advisers
Neeraj Bhala, DPhil(Oxon), FRACP, FRCPE
Consultant Gastroenterologist
Site Lead of Gastrointestinal Medicine
Queen Elizabeth Hospital Birmingham
University Hospitals Birmingham
Edgbaston
Birmingham
UK
Disclosures
NB declares that he has no competing interests.
Acknowledgements
DBMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work is retained in parts of the content:
Douglas G. Alder, MD, FACG, AGAF, FASGE
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 Boston Scientific and Merit Medical, which make endoscopic retrograde cholangiopancreatography products.
Peer reviewers
Ian Beales, BSc, FEBG, MD, MRCP
Consultant Gastroenterologist
Clinical Associate Professor
Norwich Medical School
Department of Gastroenterology
Norfolk and Norwich University Hospital
Norwich
Norfolk
UK
Disclosures
IB declares that he has no competing interests.
References
Key articles
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):311-23.Full text Abstract
Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2021. Endoscopy. 2021 Mar;53(3):300-32.Full text Abstract
National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: management. August 2016 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Oesophagitis
- Spontaneous oesophageal perforation (Boerhaave's syndrome)
- Cameron erosions
More DifferentialsGuidelines
- British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding
- Acute upper gastrointestinal bleeding in over 16s: management
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Blatchford Score for Gastrointestinal Bleeding
Rockall Score for Upper Gastrointestinal Bleeding
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