🩸 Acute Upper Gastrointestinal Bleeding Management
This tool frames acute upper GI bleeding management by type — variceal, non-variceal, or undetermined — with resuscitation, drugs, and endoscopy timing.
Acute Upper Gastrointestinal Bleeding Management
Bleeding type
Hemodynamically unstable/shock
Hemoglobin (optional) (g/L)
When to use
Use after initial resuscitation to choose drug therapy and endoscopy window, and to add variceal-specific steps when portal hypertension is the cause.
How it works
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.
Key points
- 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.
References
- Gralnek IM, et al. Endoscopic diagnosis and management of nonvariceal upper GI hemorrhage. ESGE Guideline 2021.
- de Franchis R, et al. Baveno VII — Renewing consensus in portal hypertension. J Hepatol 2022.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.