Management of Acute Upper Gastrointestinal Hemorrhage

  • David SchriftEmail author
  • Carol H. Choe


The initial management of a patient with an acute gastrointestinal hemorrhage should focus on establishing the source of the bleeding. The presence of melena and a high BUN/sCr ratio effectively rule in an upper gastrointestinal hemorrhage. Meanwhile, the nasogastric lavage has very little value in determining the source of the hemorrhage and is one of the most painful emergency department procedures. Treatment should begin with establishing appropriate intravenous access and starting volume resuscitation. Blood transfusions should be restricted to patients that remain symptomatic despite adequate fluid resuscitation or if the hemoglobin drops below 7 g/dl. Four-factor prothrombin complex concentrate is preferred over fresh frozen plasma for the reversal of coagulopathic patients on warfarin. Hemorrhaging patients receiving new oral anticoagulants are extremely challenging and require detailed knowledge of their pharmacokinetics. All patients should undergo risk stratification with the Glasgow-Blatchford Score. High-risk patients should be admitted to the intensive care unit and undergo an urgent endoscopy. Intensive proton pump inhibitor therapy should be withheld unless a high-risk lesion is demonstrated on endoscopy. Trans-arterial embolization and emergency surgery are salvage options when endoscopy fails.


Nasogastric lavage Glasgow-Blatchford Score Blood transfusion Proton pump inhibitor Warfarin New oral anticoagulants Dabigatran Rivaroxaban Prothrombin complex concentrate Fresh frozen plasma Trans-arterial embolization 

Supplementary material

Video 61.1

Duodenal ulcer with visible vessel (Courtesy of and © Dr. Julio Murra Saca (MPG 3370 kb))


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Pulmonary and Critical Care MedicineUniversity of South Carolina School of MedicineColumbiaUSA
  2. 2.Critical Care MedicineLexington Medical CenterWest ColumbiaUSA

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