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An international multidisciplinary group was convened to update guidelines for the management of patients with nonvariceal upper gastrointestinal bleeding. The group reviewed evidence from articles and meeting abstracts, graded the evidence, and rated the strength of each recommendation. Recommendations that are new or revised since the 2003 guidelines (JW Gen Med Dec 26 2003) include several that are relevant to primary care physicians:
Use prognostic scales to assess risk for rebleeding and death.
Perform blood transfusions in patients with hemoglobin levels <7 mg/dL.
Do not delay endoscopy to correct coagulopathies or to administer proton-pump inhibitor (PPI) therapy to downsize lesions.
Discharge low-risk patients soon after endoscopy.
Perfo…