Deficiencies in services for acute upper gastrointestinal bleeding

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4774 (Published 11 September 2015) Cite this as: BMJ 2015;351:h4774
  1. Alan J Lobo, honorary professor of gastroenterology12,
  2. Simon M Greenfield, chair, clinical services and standards committee 34,
  3. Ian Forgacs, president35
  1. 1Academic Unit of Gastroenterology, University of Sheffield, Sheffield S10 2TN, UK
  2. 2Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  3. 3British Society of Gastroenterology, London, UK
  4. 4Department of Gastroenterology, Lister Hospital, Stevenage, UK
  5. 5Department of Gastroenterology, King’s College Hospital, London, UK
  1. Correspondence to: alan.lobo{at}sth.nhs.uk

Patients need rapid access to specialist care round the clock

Acute upper gastrointestinal bleeding is a common and serious medical emergency. There are an estimated 50 000-70 000 hospital admissions in the United Kingdom a year1 2and overall mortality is about 10%.3 A new report by the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) identifies continuing difficulties in the provision of services for patients with substantial bleeding,4 reinforcing earlier findings from national audits5 and NHS England.6 The report focuses on patients with severe bleeding who require transfusion of at least four units of blood.

The optimum management of acute upper gastrointestinal bleeding requires a combination of circulatory resuscitation, risk assessment to help predict the need for intervention as well as outcome, administration of blood products, drug treatment, upper gastrointestinal endoscopy with haemostatic endotherapy, interventional radiology, and surgery when necessary.1 The NCEPOD report highlights deficiencies in each of these areas.

According to national audits, mortality from acute upper gastrointestinal bleeding fell in the UK between 1993-47 and 20073; the reduction was attributed, at least in part, to …

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