Emergency management of upper gastrointestinal bleeding

Badr Abulhamail, Ali Alamer, Khalid Asiri, Abdullah Alasmari, Ahmed Al Hamad, Aishah Azam, Maryam Turkistani, Abdulaziz Alghonaim, Muhannad Alshehri, Mesfer Alqahtani


Upper gastro intestinal bleeding is one of the most common reasons of emergency department visits, totaling up to 400,000 annual admissions in the United States. Peptic ulcer disease and variceal bleeding are two of the most common causes of GI bleeding. Several studies have been done, and major advancements were made in its management leading to significant drop in morbidity and mortality. Our aim is to study the common causes of upper gastrointestinal bleeding that come to the emergency department and understand the latest guidelines to manage them. We conducted this review using a comprehensive search of PubMed, MEDLINE, and EMBASE from March 1981, through November 2017. The following search terms were used: upper gastro intestinal bleeding, management of upper GI bleeding, variceal bleeding, peptic ulcer bleeding, hemorrhage in the emergency department. Acute upper gastrointestinal bleeding is one of the most common cases encountered in the emergency department and leading to significant morbidity and mortality. Clearing airway and breathing and stabilizing the vitals of the patient by achieving hemodynamic stability and bleeding control is the primary goal in the emergency department.



Upper gastro intestinal bleeding, Management of upper GI bleeding, Variceal bleeding, peptic ulcer bleeding, Hemorrhage in the emergency department

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Gralnek IM, Barkun AM, Bardou M. Current concepts: management of acute bleeding from a peptic ulcer. N Engl J Med. 2008;359:928–37.

Brown RC, Langman MJ. Proceedings: hospital admission for peptic ulcer and acute gastrointestinal bleeding in the United Kingdom, 1958–70. Gut. 1974;15(4):335.

Blatchford O, Davidson LA, Murray WR, Pell J. Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ. 1997;315(7107):510–4.

van Leerdam ME, Vreeburg EM, Rauws EA, Geraedts AA, Tijssen JG, Reitsma JB, et al. Acute upper GI bleeding:did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol. 2003;98(7):1494–9.

Yavorski RT, Wong RK, Maydonovitch C, Battin LS, Furnia A, Amundson DE. Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol. 1995;90(4):568–73.

Thomopoulos KC, Vagenas KA, Vagianos CE. Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during the last 15 years. Eur J Gastroenterol Hepatol. 2004:16(2):177–82.

Barkun A, Sabbah S, Enns R Armstrong D, Gregor J, Fedorak RN, et al. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol. 2004:99(7):1238-46.

Cooper K. Disorders of the stomach. In:Cooper K, Gasnell K, editors. Adult health nursing. 7th edition. St Louis (MO): Elsevier; 2015: 192–202.

Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107:345–60.

DeWit S, Stromberg H, Dallred C. The gastrointestinal system. In: Medical-surgical nursing. 3rd edition. St Louis (MO): Elsevier; 2017: 624–643.

Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316–21.

Srirajaskanthan R, Conn R, Bulwer C, Irving P. The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhage. Int J Clin Pract. 2010;64:868–74.

Das A, Wong RC. Prediction of outcome of acute GI hemorrhage: a review of risk scores and predictive models. Gastrointest Endosc. 2004;60:85–93.

Saltzman JR, Feldman M, Travis AC, editors. Overview of the treatment of bleeding peptic ulcers. 2017. Available at: Accessed 15 June 2017.

Sung J. Peptic ulcer disease. In: Warrell DA, Cox TM, Firth JS, editors. Oxford textbook of medicine. 5th edition. Oxford (United Kingdom): Oxford University Press: 2010: 2305–2315.

Rockall TA, Dawson HM. Gastrointestinal bleeding. In: Warrell DA, Cox TM, Firth JS, editors. Oxford textbook of medicine. 5th edition. Oxford (United Kingdom): Oxford University Press; 2010: 2233–2237.

Wang J, Hu D, Tang W, Hu C, Lu Q, Li J, et al. Simple risk factors to predict urgent endoscopy in nonvariceal upper gastrointestinal Bleeding pre-endoscopically. Medicine. 2016;95(26):1–6.

Wander P, Castaneda D, Carr-Locke D. Single center experience of an endoscopic clip in managing nonvariceal upper gastrointestinal bleeding. J Clin Gastroenterol. 2018;52(4):307-12.

Preib J, Barmeyer C, Burgel N, Daum S, Epple HJ, Günther U, et al. Hemostatic system in nonvariceal gastrointestinal bleeding results of a prospective multicenter observational pilot study. J Clin Gastroenterol. 2016;30(10):95–100.

Czernichow P, Hochain P, Nousbaum JB, Raymond JM, Rudelli A, Dupas JL, et al. Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas. Eur J Gastroenterol Hepatol. 2000;12(2):175–81.

Dursun M, Yilmaz S, Yukselen V, Canoruç F, Tuzcu A. Analysis of 1242 cases with upper gastrointestinal system bleeding in Southeastern Turkey: a different etiologic spectrum. Hepatogastroenterol. 2005;52(65):1456–8.

del Olmo JA, Pena A, Serra MA, Wassel AH, Benages A, Rodrigo JM. Predictors of morbidity and mortality after the first episode of upper gastrointestinal bleeding in liver cirrhosis. J Hepatol. 2000;32(1):19–24.

Di Fiore F, Lecleire S, Merle V, Hervé S, Duhamel C, Dupas JL, et al. Changes in characteristics and outcome of acute upper gastrointestinal haemorrhage: a comparison of epidemiology and practices between 1996 and 2000 in a multicentre French study. Eur J Gastroenterol Hepatol. 2005:17.

Sanyal AJ, Runyon BA, Robson KM, editors. General principles of the management of variceal hemorrhage. Available at: Accessed 10 June 2017.

Jackson CS, Fedorowicz Z, Oettgen P, editors. Acute variceal hemorrhage. 2013. Available at: Accessed 10 June 2017.