Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Stabilize and risk‑stratify; start PPI ± octreotide and antibiotics as indicated.
- Arrange early endoscopy with therapy (banding, clipping, injection).
- Plan secondary prevention (H. pylori eradication, variceal prophylaxis, NSAID avoidance).
Clinical Synopsis & Reasoning
Manage UGIB with ABCs, balanced transfusion targets (Hb ~7–8 g/dL), and early endoscopy (within 24 h; sooner if unstable). Use Glasgow‑Blatchford/Rockall for triage. High‑dose IV PPI for suspected non‑variceal bleeding; in suspected variceal bleeding, add octreotide and prophylactic antibiotics.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|
| CBC, CMP, INR, type & cross | Resuscitation | Transfusion planning and risk | — |
| Glasgow‑Blatchford and Rockall scores | Risk | Predict need for intervention | Disposition |
| EGD within 24 h (sooner if unstable) | Diagnosis/therapy | Identify source; endotherapy | Second look if rebleed |
High-Risk & Disposition Triggers
| Trigger | Why it matters | Action |
|---|
| Hemodynamic instability or ongoing hematemesis/melena | Active bleeding | Resuscitate; urgent endoscopy; ICU |
| Variceal bleed suspicion (cirrhosis, stigmata) | High mortality | Octreotide, antibiotics, banding; consider TIPS |
| Hemoglobin drop >2 g/dL or transfusion >4U/24 h | Severe bleed | Massive transfusion protocol; IR/surgery backup |
| Anticoagulant/antiplatelet use | Coagulopathy | Reversal strategies; cardiology input |
| Rebleeding after endotherapy | Failure | Repeat endoscopy vs IR embolization |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| IV PPI bolus + infusion for non‑variceal bleed | Acid suppression | Hours | Reduce rebleeding | Transition to PO |
| Octreotide 50 mcg bolus then 50 mcg/h (if variceal suspected) | Splanchnic vasoconstriction | Minutes | Bridge to banding/TIPS | — |
| Ceftriaxone 1 g IV daily (cirrhosis) | SBP prophylaxis | Hours | Reduce infections/rebleed | — |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- ACG/BSG UGIB guidelines — Link