Practice Guideline: Management of Nonvariceal Upper GI Bleeding

Recommendations include quick access to endoscopy and endoscopic treatment of active bleeding, followed by PPI therapy.

Following an extensive review of evidence in the literature, including new meta-analyses, a multidisciplinary group of experts (primarily Canadian) produced a clinical practice guideline for the management of nonvariceal upper gastrointestinal bleeding. Some of the key recommendations, each of which is based on at least 1 randomized trial, are the following:

Clinical and endoscopic criteria should be used to identify risks for recurrent bleeding and death.
Endoscopy should be performed within 24 hours to reduce resource utilization, particularly by allowing hospital discharge for low-risk patients.
Endoscopic injection and thermocoagulation are indicated for treatment of active bleeding or visible vessels but not of low-risk lesions; clots s…

Reviewing Author

Richard Saitz, MD, MPH, FACP, FASAM