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Upper Gastrointestinal Bleed

Also known as: UGIB · haematemesis · melaena · variceal bleed

Bleeding from the oesophagus, stomach or duodenum — haematemesis and/or melaena. Resuscitate first, risk-stratify, then endoscopy; variceal bleeds need specific therapy.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Peptic ulcer (commonest), varices (chronic liver disease), oesophagitis/Mallory-Weiss and malignancy; risk with NSAIDs/aspirin, anticoagulants and alcohol.

Red flags — escalate / refer

Shock (tachycardia, hypotension), ongoing haematemesis, or known varices/cirrhosis → major bleed: resuscitate + urgent endoscopy.

Work-up / diagnosis

1Assess haemodynamics and resuscitate simultaneously.
2Risk-score (Glasgow-Blatchford for triage; Rockall after endoscopy).
3Bloods: CBC, urea (raised in UGIB), LFTs, coagulation, and group & crossmatch; decide variceal vs non-variceal.

Management — overview

Resuscitate: two large-bore IV lines, fluids, and transfuse to a restrictive target; correct coagulopathy.
Non-variceal: IV PPI and endoscopy within 24 h for diagnosis and haemostasis; treat H. pylori and stop NSAIDs.
Variceal (suspected cirrhosis): a vasoactive drug (terlipressin/octreotide) PLUS prophylactic antibiotics PLUS urgent endoscopic band ligation; consider balloon tamponade/TIPS for uncontrolled bleeding.
Stop/reverse anticoagulants as appropriate and monitor closely.

In-depthFull dosing & advanced protocol

Drug dosing

IV fluids / blood transfusion

Resuscitation

Adult dose: Restrictive transfusion target (e.g. Hb ~7 g/dL; higher with cardiac disease/ongoing bleeding)
Route: Intravenous

Caution: Avoid over-transfusion (worse outcomes, esp. variceal).

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

IV PPI (non-variceal) + endoscopic haemostasis

Bleeding peptic ulcer

Adult dose: IV PPI; endoscopy within 24 h
Route: Intravenous

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Variceal bundle: terlipressin/octreotide + antibiotics + band ligation

Suspected/known variceal bleed

Adult dose: Vasoactive drug + prophylactic antibiotic (e.g. ceftriaxone) + urgent endoscopy
Route: IV + endoscopic

Caution: Antibiotics improve survival in variceal bleeding — give them.

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Scoring, transfusion & variceal care

Glasgow-Blatchford score triages (a score of 0 may allow outpatient management); Rockall estimates rebleeding/mortality after endoscopy.
Use a restrictive transfusion strategy unless there is haemodynamic instability or cardiac disease.
Uncontrolled variceal bleeding: balloon tamponade as a bridge, then TIPS.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV fluids / blood transfusion

IV PPI (non-variceal) + endoscopic haemostasis

Variceal bundle: terlipressin/octreotide + antibiotics + band ligation

📈 Scoring, transfusion & variceal care

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV fluids / blood transfusion

IV PPI (non-variceal) + endoscopic haemostasis

Variceal bundle: terlipressin/octreotide + antibiotics + band ligation

📈 Scoring, transfusion & variceal care

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Scoring, transfusion & variceal care

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Scoring, transfusion & variceal care

References