This guideline covers how upper gastrointestinal bleeding can be effectively managed in adults and young people aged 16 years and older. It aims to identify which diagnostic and therapeutic steps are useful so hospitals can develop a structure in which clinical teams can deliver an optimum service for people who develop this condition.
This guideline includes recommendations on:
- assessing risk
- resuscitation and initial management
- timing of endoscopy
- managing non variceal and variceal bleeding
- controlling bleeding and preventing re-bleeding in people taking NSAIDs, aspirin or clopidogrel
- primary prophylaxis for acutely ill people in critical care
- information and support
Who is it for?
- Healthcare professionals
- People over 16 with acute upper gastrointestinal bleeding, and their families and carers
Is this guideline up to date?
We reviewed the evidence in August 2016. We found nothing new that affects the recommendations in this guideline. We added a footnote to recommendation 1.7.1 covering the licensing limitations of H2-receptor antagonists and proton pump inhibitors for primary prevention of upper gastrointestinal bleeding in acutely ill patients.
Guideline development process
This guideline was previously called acute upper gastrointestinal bleeding: management.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.