Recent advances in the management of acute upper gastrointestinal bleeding

Abstract

Upper gastrointestinal bleeding is a common medical emergency with associated significant morbidity and mortality. There are multiple published national and international guidelines on the management of acute upper gastrointestinal bleeding (AUGIB). However, the 2015 National Confidential Enquiry into Patient Outcome and Death group (NCEPOD) report identified several areas of concern regarding suboptimal care. This article discusses the latest evidence and guidance on the pre-endoscopic, endoscopic and post-endoscopic management of patients presenting with AUGIB. AUGIB should be assessed for risk stratification using a validated score, such as the Glasgow-Blatchford Score, Rockall Score or AIMS65. Treatment considerations include the optimum threshold for red blood cell transfusion, as well as the reintroduction of antithrombotic agents. Novel endoscopic therapies include haemostatic powder spray, over-the-scope clips, ultrasound doppler probes and self-expandable oesophageal stents.