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Practice Guidelines

Management of acute upper gastrointestinal bleeding: summary of NICE guidance

BMJ 2012; 344 doi: (Published 13 June 2012) Cite this as: BMJ 2012;344:e3412
  1. Katharina Dworzynski, senior research fellow1,
  2. Vicki Pollit, health economist1,
  3. Amy Kelsey, project manager1,
  4. Bernard Higgins, clinical director1,
  5. Kelvin Palmer, consultant gastroenterologist2
  6. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE, UK
  2. 2Western General Hospital, Edinburgh, UK
  1. Correspondence to: K Dworzynski Katharina.Dworzynski{at}

Acute upper gastrointestinal bleeding is the commonest medical emergency managed by gastroenterologists in the United Kingdom. The most frequently identified source of bleeding is peptic ulcer disease, but other important causes exist, particularly oesophageal or gastric varices, which are classically associated with more severe bleeding. A large audit in the UK in 20071 indicated that the rate of mortality from acute upper gastrointestinal bleeding (about 7%) has not changed much over the past 50 years, and that service provision varies considerably across the UK. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of acute upper gastrointestinal bleeding.2


NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Risk assessment

At presentation with acute upper gastrointestinal bleeding, assess for risk of serious adverse events or need for intervention. To do this use the following formal risk assessment scoring systems for all patients with acute gastrointestinal bleeding: the Blatchford scoring system3 at first assessment and the full Rockall scoring system4 after endoscopy (tables 1 and 2). [Based on low to very low quality evidence from prospective and retrospective case reviews]

View this table:
Table 1

 The Blatchford scoring system.3 For a patient with acute upper gastrointestinal bleeding, add up scores in the right hand column for each risk marker (if no value applies for a particular marker, score 0) to derive a total score*

View this table:
Table 2

 The full (post-endoscopy) Rockall scoring system.4 For a patient with acute upper gastrointestinal bleeding, add up scores at the top of the …

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