Information for the public

Finding the cause of the bleeding

After the initial treatment described above, you should be offered an endoscopy. An endoscopy involves examining inside your upper gastrointestinal tract using an endoscope (a narrow, flexible tube with a camera at its tip) that is passed down your throat.

Endoscopy helps your healthcare team find the cause of the bleeding and assess the risk of further bleeding.

People with severe bleeding should have an endoscopy immediately. All other people with upper gastrointestinal bleeding should have an endoscopy within 24 hours of admission to hospital. NICE has said that healthcare teams should use an assessment called the 'Rockall' score after patients have had an endoscopy. The Rockall score helps to identify people who are at risk of bleeding again or who are at risk of further complications.

Procedures to repair the bleeding are usually done through the endoscope ('endoscopically'), rather than as 'open' surgery. While the patient is awake but sedated, the endoscope and special instruments are inserted through the mouth to the site of the bleed. Your healthcare team will be able to give you more information about endoscopic treatments.

Bleeding from stomach ulcers

If a stomach ulcer is causing the bleeding, tiny clips, heat or clotting drugs are used to coagulate the blood and stop the bleeding. These procedures are used in combination with a drug called adrenaline, which is injected directly into the ulcer to improve blood clotting. You should not be offered adrenaline on its own.

After endoscopy (but not before), you should be offered treatment with a drug called a proton pump inhibitor, which acts by reducing the amount of acid that the stomach makes.

If you bleed again or are at risk of bleeding again after treatment, you should be offered another endoscopy, and possibly more treatment, with either interventional radiology or surgery to remove the ulcer. Interventional radiology involves using scans to identify where the bleeding is coming from. A long tube, called a catheter, is fed into the body to the location of the bleeding, and the bleeding is stopped using an artificial blood clot.

Bleeding from enlarged veins

If your healthcare professional suspects that your bleeding is from enlarged veins (the medical name for this is variceal bleeding) they should offer you treatment with a drug called terlipressin. Terlipressin narrows the blood vessels to help slow the bleeding. You should also be offered antibiotics to help prevent infection.

There are different ways of treating bleeding from enlarged veins, depending on where the bleeding is coming from. Your healthcare team may use a type of elastic band or a special adhesive to stop the bleeding, or they may offer you a tube (also known as a shunt) that is inserted into the veins in the liver to improve blood flow and lower the pressure in the enlarged veins.

Questions you might like to ask your healthcare team

  • Can you tell me more about what has caused my bleeding?

  • Which treatment is best for my type of bleeding and why?

  • Are there any risks associated with this treatment?

  • What do the assessment scores show?

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