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Upper gastrointestinal (GI) bleeding is defined as hemorrhage from the mouth to the ligament of Treitz.1 The incidence of upper GI bleeding varies from 48 to 160 cases per 100,000 individuals.2 Upper GI bleeding mortality in the United States is decreasing. Upper GI bleeding accounts for 300,000 hospitalizations annually with a direct in-hospital economic burden of $3.3 billion.1,2 Patients with significant upper GI bleeding often have hemodynamic compromise and usually present to or are rapidly transported to the emergency department for resuscitation, stabilization, and hospitalization.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| The Glasgow-Blatchford bleeding score is recommended for risk stratification in upper gastrointestinal bleeding to predict a composite of various clinical interventions and mortality.3,26 | B | Prospective study comparing risk assessment tools; expert opinion/clinical review |
| Perform urgent endoscopy (e.g., within 24 hours of presentation) after fluid resuscitation and stabilization in patients with upper gastrointestinal bleeding and hemodynamic instability.30 | C | Expert opinion from consensus guideline |
| Initiation of a proton pump inhibitor should not be delayed before endoscopy and should be started upon presentation with upper gastrointestinal bleeding.33 | C | Cochrane review with disease-oriented outcomes |
| Oral proton pump inhibitors can be used because there was no difference between oral and intravenous proton pump inhibitors in regard to recurrent bleeding, surgery, or mortality.34 | A | Consistent evidence from a meta-analysis of nine randomized controlled trials |
| High-dose proton pump inhibitor treatment is recommended for the first 72 hours post-endoscopy because this is when the rebleeding risk is highest.5 | C | Expert opinion from consensus guideline |
| Repeat endoscopy is recommended in persons with rebleeding.35 | B | Evidence from a small randomized controlled trial |
| Aspirin for secondary cardiovascular prevention should be resumed immediately following endoscopy if the rebleeding risk is low or within three days if the rebleeding risk is moderate to high.5 | C | Expert opinion from consensus guideline |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to
Risk Factors
The most common risk factors for upper GI bleeding include prior upper GI bleeding (relative risk [RR] = 13.5), anticoagulant use (RR = 12.7), high-dose nonsteroidal anti-inflammatory...