Acute upper gastrointestinal haemorrhage

Acute upper gastrointestinal (GI) haemorrhage is one of the most common GI emergencies. Bleeding from peptic ulcer disease and variceal haemorrhage are the most frequently observed causes of haemorrhage. Mortality is increased in the elderly, patients with liver disease and those who present with shock. The use of risk stratification scores such as the Glasgow Blatchford or Rockall scores is recommended in all patients to predict the need for endoscopic intervention or death. Appropriate resuscitation of the patient is the first priority. Early access to upper GI endoscopy for diagnosis and therapy is essential for patients with acute bleeding. Peptic ulcers with active bleeding should undergo dual endoscopic therapy followed by 72-hour infusion of intravenous proton pump inhibitor. For oesophageal varices that are bleeding, band ligation therapy is the endoscopic treatment of choice. Patients with chronic liver disease should be given prophylactic antibiotic therapy following endoscopy to reduce the incidence of complications (sepsis, re-bleeding) and reduce risk of death. Transjugular intrahepatic portosystemic shunt is an appropriate rescue therapy when endoscopic techniques fail or re-bleeding occurs. New endoscopic haemostatic methods, including Hemospray®, a novel powder haemostat, offer the prospect of improved haemostasis but need further evaluation.