NICE, the healthcare guidance body, has today (Wednesday 13 June) published a new guideline on the management of acute upper gastrointestinal (GI) bleeding.

Bleeding in the oesophagus, stomach or duodenum is the most common emergency managed by gastroenterologists in the UK, with at least 50,000 hospital admissions per year.

Despite changes in management, mortality has not improved over the past 50 years. It is estimated that around one in ten hospital admissions for upper gastrointestinal bleeding results in the patient's death - around 5000 deaths per year in the UK.

Upper gastrointestinal bleeding is usually caused by peptic ulcers, which can bleed as the ulcer erodes into an underlying artery, or oesophago-gastric varices (dilated veins in the oesophagus).

The guideline makes a number of key recommendations, including:

• Offer endoscopy to unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation.
• Offer endoscopy within 24 hours of admission to all other patients with upper gastrointestinal bleeding.
• Offer interventional radiology to unstable patients who re-bleed after endoscopic treatment. Refer urgently for surgery if interventional radiology is not promptly available.
• Continue low-dose aspirin for secondary prevention of vascular events in patients with upper gastrointestinal bleeding in whom haemostasisⁱ has been achieved.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE said: “Although there have been changes in how upper gastrointestinal tract bleeding is managed, mortality has not improved much over the past 50 years and thousands of people still die from the condition every year. There are also variations in care; some hospitals provide a comprehensive, 24/7 service involving endoscopy, interventional radiology and emergency surgery, while others do not. The reported expertise of endoscopists varies widely with approximately 30% being unable to manage bleeding oesophageal varices. We are, therefore, pleased to be publishing this guideline on the management of acute upper gastrointestinal bleeding, which includes a number of key recommendations, such as rapid access to endoscopies for all patients with upper GI bleeding. It will, I am sure, be a useful aid to all healthcare professionals involved in the care and treatment of this condition.”

The guideline also addresses risk assessment, resuscitation and initial management, timing of endoscopy, controlling bleeding and preventing re-bleeding, and information and support for patients and carers.

Ends

Notes to Editors

References and explanation of terms

i. Haemostasisrefers to the stoppage of bleeding.

About the clinical guideline

The guideline will be available on the NICE website from Wednesday 13 June. Embargoed copies of the guideline are available on request; please contact the press office.

Related NICE guidance

1. Stent insertion for bleeding oesophageal varices. NICE interventional procedure guidance 392 (2011).

2. Alcohol-use disorders. NICE clinical guideline 100 (2010).

3. Unstable angina and NSTEMI. NICE clinical guideline 94 (2010).

4. Prevention of cardiovascular disease at population level. NICE public health guidance 25 (2010).

5. Stroke. NICE clinical guideline 68 (2008).

6. Osteoarthritis. NICE clinical guideline 59 (2008).

7. Acutely ill patients in hospital. NICE clinical guideline 50 (2007).

8. MI: secondary prevention. NICE clinical guideline 48 (2007).

9. Atrial fibrillation. NICE clinical guideline 36 (2006).

10. Dyspepsia. NICE clinical guideline 17 (2004).

11. Wireless capsule endoscopy for investigation of the small bowel. NICE interventional procedure guidance 101 (2004)

About NICE

12. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

13. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS

14. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

15. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.