Upper Gastrointestinal and Ulcer Bleeding

Patient Guideline Summary

Publication Date: April 30, 2021

Last Updated: March 3, 2023

Objective

This patient summary means to summarize key recommendations from the American College of Gastroenterology (ACG) guideline for the upper gastrointestinal and ulcer bleeding.

Overview

If you have upper gastrointestinal bleeding, your care team may consist of an emergency medicine doctor, gastroenterologist, surgeon, or other allied providers.

Gastrointestinal disease is a disease affecting any part of the gastrointestinal (GI) tract from the mouth to the anus.

Gastrointestinal (GI) bleeding is a common medical condition.

There is an upper and lower GI tract, and bleeding can happen in either, but this summary focuses on Upper GI bleeding.

Upper GI bleeding originates from the esophagus (the tube that connects the mouth and the stomach), stomach, or duodenum (the first part of the small intestine).
We will use the abbreviation (UGIB) throughout this guide to refer to Upper GI bleeding. We will use overt UGIB to describe upper GI bleeding with visible blood.
Ulcer bleeding is the most common cause of UGIB.

Symptoms include vomiting of red blood or coffee-ground material, black, tarry stool, or red or maroon material per rectum.

This patient summary focuses primarily on endoscopic therapies (treating the bleeding by inserting an instrument [endoscope] to visualize it and using a drug or a non-surgical technique to stop the bleeding) and post-endoscopic management for patients with visible UGIB bleeding.

Evaluation and Diagnosis

Overview of Risk Stratification
- The first step to getting your UGIB under control is an evaluation to determine your risk category.
- Your risk is based on the Glasgow-Blatchford score. Your hemoglobin levels, blood urea nitrogen, blood pressure, heart rate, and other co-occurring conditions that affect your risk score.
- Risk categories include very low clinical risk and not very-low clinical risk.

Management

If you are a very low risk (Glasgow-Blatchford score 0–1) and if there is no other reason for hospitalization, you will probably leave the hospital and be scheduled for a follow-up.
If you have UGIB, you will possibly get a red blood cell transfusion (transfer of blood or blood element from one person to another person) if your hemoglobin is 7 g/dL or less.
If you have UGIB, you will possibly receive an antibiotic like erythromycin 250 mg injected into your vein 30-90 minutes before the upper endoscopy (a procedure when the healthcare provider inserts an instrument with a camera at the end to look inside your body).
If you have UGIB, you will possibly get upper endoscopy (inserting an instrument to see a part of the body) within 24 hours of presentation.
If you have UGIB with actively bleeding blood vessels and also visible vessels that are not bleeding, you will probably get endoscopic therapy (treating the bleeding by inserting an instrument [endoscope] to visualize it and using a drug or a non-surgical technique to stop the bleeding).
If you have a bleeding ulcer, there are several ways to stop the bleeding through an endoscope. Blood vessels can be closed off with heat, an electric current, a tiny metal clamp, or an injection of pure (100%) alcohol or other chemicals.
If you have successful endoscopic hemostatic therapy (treatment to stop bleeding) for a bleeding ulcer, you may get high-dose proton pump inhibitor (PPI) therapy (drugs that reduce stomach acid) for a few days. The dose will then most likely be reduced as you leave the hospital.
A couple of weeks after another endoscopy shows you are healing, the PPI may be stopped.
If you start bleeding again, the choice of treatment could be repeat endoscopy, surgery, or transcatheter arterial embolization (a procedure that inserts a long, thin device into a blood vessel, threads it to the bleeding site, and places a plug in the bleeding vessel).

Abbreviations

GI: Gastrointestinal
PPI: Proton Pump Inhibitor
UGIB: Upper Gastrointestinal Bleeding

Source Citation

Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917. doi: 10.14309/ajg.0000000000001245. Erratum in: Am J Gastroenterol. 2021 Nov 1;116(11):2309. PMID: 33929377.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.