Practice Guidelines

Management of acute gastrointestinal blood loss: summary of SIGN guidelines

BMJ 2008; 337 doi: (Published 10 October 2008) Cite this as: BMJ 2008;337:a1832
  1. K Palmer, consultant gastroenterologist1,
  2. M Nairn, programme manager2
  3. on behalf of the Guideline Development Group
  1. 1Western General Hospital, Crewe Road, Edinburgh EH4 2XU
  2. 2Scottish Intercollegiate Guidelines Network, Edinburgh EH7 5EA
  1. Correspondence to: M Nairn moray.nairn{at}

    Why read this summary?

    Acute gastrointestinal bleeding is a common major medical emergency, accounting for about 7600 admissions to hospitals each year in Scotland. Overall mortality of patients admitted to hospital because of acute gastrointestinal bleeding is 7%, rising to 26% in patients who bleed during admissions to hospital for other reasons.1 This article summarises the most recent guidance from the Scottish Intercollegiate Guidelines Network (SIGN) on the management of acute upper and lower gastrointestinal blood loss that is sufficiently severe to lead to emergency admission to hospital (see the full SIGN guidance, guideline 105, at


    SIGN recommendations are based on systematic reviews of best available evidence, and the strength of the evidence is indicated as A, B, C, or D (fig 1). Recommended best practice (“good practice points”) based on the clinical experience of the guideline development group is also indicated (as GPP).

    Fig 1 Explanation of SIGN grades of recommendations

    Assessment and triage

    • Estimate the risks of death and uncontrolled bleeding for all patients who present with haematemesis, melaena, or haematochezia. The best risk assessment scoring tool for patients with upper gastrointestinal bleeding is the Rockall score (D).2 There is no validated assessment scoring system for lower gastrointestinal bleeding, but it is accepted that all shocked patients with lower gastrointestinal bleeding should be admitted to hospital (GPP). The boxes on provide initial assessment protocols for the admission or discharge of patients with upper or lower gastrointestinal bleeding.

    • When assigning patients to different levels of care, take into account other clinical factors as well as the Rockall score. The Rockall score should not be used in isolation to assign patients to high dependency units, intensive care units, or other levels of care (D).

    Models of care

    Admit acutely bleeding patients to a dedicated gastrointestinal bleeding unit in which there is appropriate monitoring …

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