Skip to main content
PMC home page
Gut logoLink to Gut
. 2002 Oct;51(Suppl 4):iv1–iv6. doi: 10.1136/gut.51.suppl_4.iv1

Non-variceal upper gastrointestinal haemorrhage: guidelines

K Palmer
PMCID: PMC1867732  PMID: 12208839

Full Text

The Full Text of this article is available as a PDF (137.3 KB).

Figure 1 .

Figure 1

Open in a new tab

Algorithm for the management of acute gastrointestinal haemorrhage. HDU, high dependency unit; NDAIDS, non-steroidal anti-inflammatory drugs; SRH, stigmata of recent haemorrhage.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barer D., Ogilvie A., Henry D., Dronfield M., Coggon D., French S., Ellis S., Atkinson M., Langman M. Cimetidine and tranexamic acid in the treatment of acute upper-gastrointestinal-tract bleeding. N Engl J Med. 1983 Jun 30;308(26):1571–1575. doi: 10.1056/NEJM198306303082606. [DOI] [PubMed] [Google Scholar]
  2. Bornman P. C., Theodorou N. A., Shuttleworth R. D., Essel H. P., Marks I. N. Importance of hypovolaemic shock and endoscopic signs in predicting recurrent haemorrhage from peptic ulceration: a prospective evaluation. Br Med J (Clin Res Ed) 1985 Jul 27;291(6490):245–247. doi: 10.1136/bmj.291.6490.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Choudari C. P., Palmer K. R. Endoscopic injection therapy for bleeding peptic ulcer; a comparison of adrenaline alone with adrenaline plus ethanolamine oleate. Gut. 1994 May;35(5):608–610. doi: 10.1136/gut.35.5.608. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Choudari C. P., Rajgopal C., Palmer K. R. Comparison of endoscopic injection therapy versus the heater probe in major peptic ulcer haemorrhage. Gut. 1992 Sep;33(9):1159–1161. doi: 10.1136/gut.33.9.1159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chung I. K., Ham J. S., Kim H. S., Park S. H., Lee M. H., Kim S. J. Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc. 1999 Jan;49(1):13–18. doi: 10.1016/s0016-5107(99)70439-6. [DOI] [PubMed] [Google Scholar]
  6. Chung S. C., Leung J. W., Leong H. T., Lo K. K., Li A. K. Adding a sclerosant to endoscopic epinephrine injection in actively bleeding ulcers: a randomized trial. Gastrointest Endosc. 1993 Sep-Oct;39(5):611–615. doi: 10.1016/s0016-5107(93)70208-4. [DOI] [PubMed] [Google Scholar]
  7. Chung S. C., Leung J. W., Steele R. J., Crofts T. J., Li A. K. Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial. Br Med J (Clin Res Ed) 1988 Jun 11;296(6637):1631–1633. doi: 10.1136/bmj.296.6637.1631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Chung S. S., Lau J. Y., Sung J. J., Chan A. C., Lai C. W., Ng E. K., Chan F. K., Yung M. Y., Li A. K. Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers. BMJ. 1997 May 3;314(7090):1307–1311. doi: 10.1136/bmj.314.7090.1307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cipolletta L., Bianco M. A., Rotondano G., Piscopo R., Prisco A., Garofano M. L. Prospective comparison of argon plasma coagulator and heater probe in the endoscopic treatment of major peptic ulcer bleeding. Gastrointest Endosc. 1998 Aug;48(2):191–195. doi: 10.1016/s0016-5107(98)70163-4. [DOI] [PubMed] [Google Scholar]
  10. Cook D. J., Guyatt G. H., Salena B. J., Laine L. A. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology. 1992 Jan;102(1):139–148. doi: 10.1016/0016-5085(92)91793-4. [DOI] [PubMed] [Google Scholar]
  11. Daneshmend T. K., Hawkey C. J., Langman M. J., Logan R. F., Long R. G., Walt R. P. Omeprazole versus placebo for acute upper gastrointestinal bleeding: randomised double blind controlled trial. BMJ. 1992 Jan 18;304(6820):143–147. doi: 10.1136/bmj.304.6820.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Forrest J. A., Finlayson N. D., Shearman D. J. Endoscopy in gastrointestinal bleeding. Lancet. 1974 Aug 17;2(7877):394–397. doi: 10.1016/s0140-6736(74)91770-x. [DOI] [PubMed] [Google Scholar]
  13. Fullarton G. M., Birnie G. G., Macdonald A., Murray W. R. Controlled trial of heater probe treatment in bleeding peptic ulcers. Br J Surg. 1989 Jun;76(6):541–544. doi: 10.1002/bjs.1800760606. [DOI] [PubMed] [Google Scholar]
  14. Griffiths W. J., Neumann D. A., Welsh J. D. The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med. 1979 Jun 21;300(25):1411–1413. doi: 10.1056/NEJM197906213002503. [DOI] [PubMed] [Google Scholar]
  15. Hasselgren G., Lind T., Lundell L., Aadland E., Efskind P., Falk A., Hyltander A., Söderlund C., Eriksson S., Fernström P. Continuous intravenous infusion of omeprazole in elderly patients with peptic ulcer bleeding. Results of a placebo-controlled multicenter study. Scand J Gastroenterol. 1997 Apr;32(4):328–333. doi: 10.3109/00365529709007680. [DOI] [PubMed] [Google Scholar]
  16. Henry D. A., O'Connell D. L. Effects of fibrinolytic inhibitors on mortality from upper gastrointestinal haemorrhage. BMJ. 1989 Apr 29;298(6681):1142–1146. doi: 10.1136/bmj.298.6681.1142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Holman R. A., Davis M., Gough K. R., Gartell P., Britton D. C., Smith R. B. Value of a centralised approach in the management of haematemesis and melaena: experience in a district general hospital. Gut. 1990 May;31(5):504–508. doi: 10.1136/gut.31.5.504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hébert P. C., Wells G., Blajchman M. A., Marshall J., Martin C., Pagliarello G., Tweeddale M., Schweitzer I., Yetisir E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999 Feb 11;340(6):409–417. doi: 10.1056/NEJM199902113400601. [DOI] [PubMed] [Google Scholar]
  19. Imperiale T. F., Birgisson S. Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Ann Intern Med. 1997 Dec 15;127(12):1062–1071. doi: 10.7326/0003-4819-127-12-199712150-00002. [DOI] [PubMed] [Google Scholar]
  20. Khuroo M. S., Yattoo G. N., Javid G., Khan B. A., Shah A. A., Gulzar G. M., Sodi J. S. A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med. 1997 Apr 10;336(15):1054–1058. doi: 10.1056/NEJM199704103361503. [DOI] [PubMed] [Google Scholar]
  21. Kubba A. K., Murphy W., Palmer K. R. Endoscopic injection for bleeding peptic ulcer: a comparison of adrenaline alone with adrenaline plus human thrombin. Gastroenterology. 1996 Sep;111(3):623–628. doi: 10.1053/gast.1996.v111.pm8780566. [DOI] [PubMed] [Google Scholar]
  22. Laine L. Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage. A prospective controlled trial. N Engl J Med. 1987 Jun 25;316(26):1613–1617. doi: 10.1056/NEJM198706253162601. [DOI] [PubMed] [Google Scholar]
  23. Langman M. J., Morgan L., Worrall A. Use of anti-inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage. Br Med J (Clin Res Ed) 1985 Feb 2;290(6465):347–349. doi: 10.1136/bmj.290.6465.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Larson G., Schmidt T., Gott J., Bond S., O'Connor C. A., Richardson J. D. Upper gastrointestinal bleeding: predictors of outcome. Surgery. 1986 Oct;100(4):765–773. [PubMed] [Google Scholar]
  25. Lau J. Y., Sung J. J., Lam Y. H., Chan A. C., Ng E. K., Lee D. W., Chan F. K., Suen R. C., Chung S. C. Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med. 1999 Mar 11;340(10):751–756. doi: 10.1056/NEJM199903113401002. [DOI] [PubMed] [Google Scholar]
  26. Lau J. Y., Sung J. J., Lee K. K., Yung M. Y., Wong S. K., Wu J. C., Chan F. K., Ng E. K., You J. H., Lee C. W. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med. 2000 Aug 3;343(5):310–316. doi: 10.1056/NEJM200008033430501. [DOI] [PubMed] [Google Scholar]
  27. Lazo M. D., Andrade R., Medina M. C., Garcia-Fernandez G., Sanchez-Cantos A. M., Franquelo E. Effect of injection sclerosis with alcohol on the rebleeding rate of gastroduodenal peptic ulcers with nonbleeding visible vessels: a prospective, controlled trial. Am J Gastroenterol. 1992 Jul;87(7):843–846. [PubMed] [Google Scholar]
  28. Levy J., Khakoo S., Barton R., Vicary R. Fatal injection sclerotherapy of a bleeding peptic ulcer. Lancet. 1991 Feb 23;337(8739):504–504. doi: 10.1016/0140-6736(91)93452-f. [DOI] [PubMed] [Google Scholar]
  29. Lin H. J., Lo W. C., Lee F. Y., Perng C. L., Tseng G. Y. A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy. Arch Intern Med. 1998 Jan 12;158(1):54–58. doi: 10.1001/archinte.158.1.54. [DOI] [PubMed] [Google Scholar]
  30. Millat B., Hay J. M., Valleur P., Fingerhut A., Fagniez P. L. Emergency surgical treatment for bleeding duodenal ulcer: oversewing plus vagotomy versus gastric resection, a controlled randomized trial. French Associations for Surgical Research. World J Surg. 1993 Sep-Oct;17(5):568–574. doi: 10.1007/BF01659109. [DOI] [PubMed] [Google Scholar]
  31. Oddsson E., Gudjónsson H., Thjódleifsson B. Comparison between ranitidine and omeprazole for protection against gastroduodenal damage caused by naproxen. Scand J Gastroenterol. 1992 Dec;27(12):1045–1048. doi: 10.3109/00365529209028136. [DOI] [PubMed] [Google Scholar]
  32. Pearson J., Dudley H. A. Bodily perceptions in surgical patients. Br Med J (Clin Res Ed) 1982 May 22;284(6328):1545–1546. doi: 10.1136/bmj.284.6328.1545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Rockall T. A., Logan R. F., Devlin H. B., Northfield T. C. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ. 1995 Jul 22;311(6999):222–226. doi: 10.1136/bmj.311.6999.222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Rockall T. A., Logan R. F., Devlin H. B., Northfield T. C. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996 Mar;38(3):316–321. doi: 10.1136/gut.38.3.316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Rutgeerts P., Rauws E., Wara P., Swain P., Hoos A., Solleder E., Halttunen J., Dobrilla G., Richter G., Prassler R. Randomised trial of single and repeated fibrin glue compared with injection of polidocanol in treatment of bleeding peptic ulcer. Lancet. 1997 Sep 6;350(9079):692–696. doi: 10.1016/s0140-6736(97)03233-9. [DOI] [PubMed] [Google Scholar]
  36. Sanderson J. D., Taylor R. F., Pugh S., Vicary F. R. Specialized gastrointestinal units for the management of upper gastrointestinal haemorrhage. Postgrad Med J. 1990 Aug;66(778):654–656. doi: 10.1136/pgmj.66.778.654. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Santander C., Grávalos R. G., Gómez-Cedenilla A., Cantero J., Pajares J. M. Antimicrobial therapy for Helicobacter pylori infection versus long-term maintenance antisecretion treatment in the prevention of recurrent hemorrhage from peptic ulcer: prospective nonrandomized trial on 125 patients. Am J Gastroenterol. 1996 Aug;91(8):1549–1552. [PubMed] [Google Scholar]
  38. Savides T. J., Jensen D. M. Therapeutic endoscopy for nonvariceal gastrointestinal bleeding. Gastroenterol Clin North Am. 2000 Jun;29(2):465-87, vii. doi: 10.1016/s0889-8553(05)70123-0. [DOI] [PubMed] [Google Scholar]
  39. Schaffalitzky de Muckadell O. B., Havelund T., Harling H., Boesby S., Snel P., Vreeburg E. M., Eriksson S., Fernström P., Hasselgren G. Effect of omeprazole on the outcome of endoscopically treated bleeding peptic ulcers. Randomized double-blind placebo-controlled multicentre study. Scand J Gastroenterol. 1997 Apr;32(4):320–327. doi: 10.3109/00365529709007679. [DOI] [PubMed] [Google Scholar]
  40. Schein M., Gecelter G. APACHE II score in massive upper gastrointestinal haemorrhage from peptic ulcer: prognostic value and potential clinical applications. Br J Surg. 1989 Jul;76(7):733–736. doi: 10.1002/bjs.1800760729. [DOI] [PubMed] [Google Scholar]
  41. Swain C. P., Storey D. W., Bown S. G., Heath J., Mills T. N., Salmon P. R., Northfield T. C., Kirkham J. S., O'Sullivan J. P. Nature of the bleeding vessel in recurrently bleeding gastric ulcers. Gastroenterology. 1986 Mar;90(3):595–608. doi: 10.1016/0016-5085(86)91113-3. [DOI] [PubMed] [Google Scholar]
  42. Vreeburg E. M., Terwee C. B., Snel P., Rauws E. A., Bartelsman J. F., Meulen J. H., Tytgat G. N. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut. 1999 Mar;44(3):331–335. doi: 10.1136/gut.44.3.331. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES