Guideline on Managing Acute Upper Gastrointestinal Bleeding Updated

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

An international consensus group has updated its 2010 guidelines on managing nonvariceal upper gastrointestinal bleeding (UGIB) in the Annals of Internal Medicine. Among the changed recommendations:

• Resuscitation should be started for patients with acute UGIB and hemodynamic instability.

• Clinicians should use a Glasgow Blatchford score of 1 or under to determine whether patients are at very low risk for rebleeding or mortality. These patients may not require hospitalization.

• A hemoglobin threshold of 80 g/L should be used for blood transfusion in patients without cardiovascular disease. Patients with cardiovascular disease require a higher threshold.

• Endoscopy should be used within 24 hours of presentation for patients admitted with acute UGIB.

• High-dose proton-pump inhibitor therapy is recommended for 3 days in patients with bleeding ulcers with high-risk stigmata who've had a successful endoscopy.

• Patients with a history of ulcer bleeding who take antiplatelets or anticoagulants for cardiovascular prophylaxis may be prescribed PPIs.

An editorialist writes: "The recommendations for managing patients receiving antiplatelets or anticoagulants and for the appropriate use of new therapeutic endoscopic techniques should be particularly helpful to clinicians."