NICE publishes new guideline on the management of acute upper gastrointestinal bleeding
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.