Acute Upper Gastrointestinal Bleeding Management — free guideline decision tool

This tool frames acute upper GI bleeding management by type — variceal, non-variceal, or undetermined — with resuscitation, drugs, and endoscopy timing.

Restrictive transfusion Hb < 70 g/L. Non-variceal → high-dose IV PPI + endoscopy < 24 h. Variceal → vasoactive drug + prophylactic antibiotics + endoscopy < 12 h. Undetermined severe → empiric somatostatin + PPI.

Use after initial resuscitation to choose drug therapy and endoscopy window, and to add variceal-specific steps when portal hypertension is the cause.

Prophylactic antibiotics are part of variceal-bleed management, not just an option, because they reduce infection and rebleeding in cirrhosis. (original synthesis · not guideline verbatim) Hemodynamic instability prioritizes resuscitation, with endoscopy performed after stabilization. Failed variceal endoscopic control bridges to TIPS or balloon tamponade.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Bleeding type Undetermined cause (emergency major bleeding), Hemodynamically unstable/shock Yes, Hemoglobin (optional) 75 g/L → Result: Disposition Empiric somatostatin + PPI, endoscopy early（Resuscitation & transfusion: Fluid resuscitation, transfuse if needed (restrictive threshold Hb < 70 g/L; relax individually for active major bleeding or comorbid cardiovascular disease), monitoring, crossmatch, correct coagulopathy; in hemodynamic instability, prioritize resuscitation and perform endoscopy after stabilization, Drugs: Severe bleeding of undetermined cause: empiric somatostatin (or octreotide) + IV PPI combined, Endoscopy timing: Once hemodynamically stable, emergency endoscopy as early as possible (within 24 h) to identify the cause and achieve hemostasis） Inputs: Bleeding type Variceal (cirrhosis/portal hypertension), Hemodynamically unstable/shock No, Hemoglobin (optional) 75 g/L → Result: Disposition Vasoactive drug + antibiotics + endoscopy within 12 h（Resuscitation & transfusion: Fluid resuscitation, transfuse if needed (restrictive threshold Hb < 70 g/L; relax individually for active major bleeding or comorbid cardiovascular disease), monitoring, crossmatch, correct coagulopathy, Drugs: Early vasoactive drug (somatostatin/octreotide/terlipressin) + prophylactic antibiotics (e.g. ceftriaxone); may combine with IV PPI, Endoscopy timing: Emergency endoscopy within 12 h, band ligation or sclerotherapy）