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Upper GI bleeding guidance published

8037901-article-hospitaldoctorsNICE has published new recommendations 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 5,000 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.

This latest guidance makes a number of key recommendations, including offering endoscopy to unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation.

Endoscopy should also be offered within 24 hours of admission to all other patients with upper gastrointestinal bleeding.

Interventional radiology should be offered to unstable patients who re-bleed after endoscopic treatment. Patients should be referred urgently for surgery if interventional radiology is not promptly available.

NICE recommends that that treatment with low-dose aspirin should be continued for secondary prevention of vascular events in patients with upper gastrointestinal bleeding in whom haemostasis 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 per cent 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.”

25 June 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.